Is there really a physician shortage, and do we need more medical schools?

“Whether you think you can, or think you can’t, you’re right,” said Henry Ford noting how our mindset shapes our behavior. Now, let’s talk about our American mindset on healthcare, which is that  ”more is needed” and that doctors are the most important players.

In a recent message to all physicians, Dr. Cecil B. Wilson, former president  of the American Medical Association, calls on us to help take vigorous action to solve the growing crisis of too few physicians.

Dr.  Wilson wants to expand medical schools, lower the cost of medical  education, and create a new mechanism for funding graduate  medical education.  He claims it will be “not only unacceptable,”  but “morally reprehensible” not to take strong action to increase  the doctor supply.

As a physician and a member of the AMA, I  don’t think this is a good idea for a lot of reasons.  First let’s get real, and admit that the overwhelming majority of healthcare in  America is rendered for preventable conditions.

Resources would be better spent on prevention.

Let’s  help people change their lives, not just sell them more healthcare.   The healthcare system is selling healthcare, when what we need is  health.

Whether you think you can, or think you can’t, you’re right,” said Henry Ford, whose introduction of the Model T  automobile revolutionized transportation and American  industry.

In addition, a significant fraction of healthcare has been judged useless or harmful, and doctors clearly  are capable of creating their own demand. Why do hospitals always  want more procedure-oriented specialists on staff?

It’s simple, when the doctor supply goes up — the amount of care, and the profits, rise too.

I’m not blaming physicians for this problem, the causes of  inappropriate care are complex, but if we just got rid of  unnecessary care, would we have a “physician shortage?”

Lastly,  historically doctors have acted aggressively to protect their  turf – both as a profession and within specialties. How much  routine healthcare could be rendered by nurse practitioners,  nurses, pharmacists and other more numerous and less costly  providers?

Studies suggest that a huge fraction of care  doesn’t need to be rendered by a doctor, but what prevents this? You  know the answer — the physician lobby.

In aggregate, America spends more on healthcare than other societies and gets less for it.

We’ve  spent more on healthcare each year for decades, yet we still think we  need more? The “physician shortage” is a creation of the physician  associations and the way we collectively think.

However, if  you think as I do — that health doesn’t come from healthcare; that we  should be working to have more health and less care; and that  non-physician providers can do much more — then there  is no “physician shortage.”

So with all due respect Dr. Wilson, the “physician shortage” is in your head.

Peter J. Weiss is an internal medicine physician and former health plan CEO.  He is author of More Health Less Care and can be reached at More Health, Less Care: Building America’s Wellness System.

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  • Rockspinner182

    Doc W.  Gutsy commentary.  I agee with many of your points.  Thanks for the moral courage to say what many of us believe though few of us say.  A good thing that Stoning is out of vogue.

    - ICU Lu

  • Anonymous

    “. . .the overwhelming majority of healthcare in  America is rendered for preventable conditions.”  Really?  How do you define preventable?  Do you have studies to back you up?

    My husband has leukemia.  How could he have prevented it?  How do we get him more health without more care? Should he be treated by nurses and other “health professionals” or might he have the right to actually see a doctor.

    I have two autoimmune conditions.  No prevention there.  They are complicated by a genetic collagen disorder.  What exactly could I have done to prevent that?  How do I get more health without more care?  Do you really think that non-doctors have the expertise to manage the conflicting demands on treatment that a complicated patient like me can present?

    Sure, let’s get rid of unnecessary and harmful care.  I’m all for denying hip replacements to end-stage Alzheimer’s patients.  But who gets to decide what is unnecessary?  Who gets to decide what is harmful?

    Limiting access to physicians increases insurance company profits.

    Your health plan CEO background is showing, doctor.

    • Adam Peterson

      I think he was referring to the thousands of americans who die each year from some sort of cardiovascular disease issue, and how the majority of those cases are completely preventable if Americans got out and jogged a little more and visited mcdonalds less. No objection to your evidence- people with leukemia and genetically inherited conditions do need care-but leukemia is not preventable like obesity, (most) type II diabetes, gout, HTN, CHF, etc. I think this was probably the point he was trying to make; an overweight american (of which there are many) probably doesn’t need to see a doctor to be told he/she’s overweight and needs to lose it. That patient needs to go see a personal trainer/exercise, and that doctor’s time would be better served helping a leukemia or skin cancer, or “non-preventable” disease ridden patient. 

      • http://twitter.com/USMCShrink Kevin Nasky

        Agree, to an extent. The author’s argument seems to be that we can somehow shift resources from minting new docs to prevention. Okay, so where is the evidence that prevention efforts actually work? I believe we’re talking about diet/exercise, right?  So great, that sounds laudable, but what are we talking about here? More funding for public service announcements? (Because people don’t know eating Big Macs and being sedentary are bad for you, right) Are are we talking about something that hasn’t been done yet, i.e. funding for ‘lifestyle coaches’ (Don’t eat that!  Are you sitting again? Get up, do some jumping jacks! Give me that cigarette!)  If something along the lines of the latter, then where is the research indicating that that’d even work? This is one of those ideas that, at first glance, looks great (Lets put more resources into prevention!). But I’d love to see the specifics.  Better yet, I’d love to see some evidence supporting that such a diversion in funding would work.  There’s a bigger question here regarding how much hand-holding we should be doing (is it gov’t responsibility to promote health?) that I’ll leave for another day.

        • Anonymous

          When you shift resources from minting new docs to “prevention,” there are even fewer docs to take care of people like me and my husband who have our illnesses through no fault of our own.  That’s my point.

          A secondary point is that we should be very careful about assuming that many diseases ARE preventable.  My fil, the healthiest-liver I ever met, developed CHF in his later years.  We all die of something, don’t we? 

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    There is an implied assumption in this argument that physicians are, and should remain, highly paid resources and therefore beyond the reach of many folks. Of course educating more physicians will create pressure on that perception. I believe this was one of the reasons why the AMA originally restricted the number of medical schools.

    I find it interesting that the AMA is now more concerned with a completely different threat, so expanding the number of physicians, which might lower physician pay, is perceived a better solution than abdicating the monopoly on licensing medical practice. I actually think that the AMA is correct in its new advocacy, and I think that it is probably in the best long term interest of both patients and the profession, to accept a hit on immediate earnings, but maintain control on licensure to practice. At least that way you live to fight another day.

  • http://twitter.com/#!/CloseCall_MD Close Call

    Stoning?  What is this, a Shirley Jackson short story?

    Beware the secondary consequences.  How are we to assume that these newly minted NPs won’t be as eager to unionize as their RN counterparts?  Walgreens NPs are doing it.  Who is to say they won’t strike as frequently as their RN counterparts?  Suddenly, a well organized, powerful NP union with great bargaining power and no compunction about striking doesn’t look so cost effective or great for patient care.  

    Finally, just because we have studies showing that in certain cases NPs provide just as “effective” care as IM or FP docs doesn’t mean these are good studies or can be widely applied.  I bet I could do a study showing that teenagers can be trained to be just as good at reading xrays or mammograms as radiologists (ALERT!! free research idea for pre-meds wanting boost their applications!!!).  Would Dr. Weiss like his mother, wife or daughter’s mammogram being read by a teenager without physician oversight?  Here are the studies to back it up!

    There are other ways to reduce unnecessary care besides elevating NPs to physician status…. like
    … binding arbitration  (that’s not the only one, by the way, but the most obvious).

  • Anonymous

    There is absolutely no shortage of physicians.

    There is an infinte shortage of physicians able to work for less than the cost of doing business.

  • sbahrych

    I think a part of the answer can be found by using the patient centered medical home model, a team approach where everyone participates to their fullest extent.  -sharon bahrych, pac, mph (blog: http://paviewonmedicine.blogspot.com)

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