In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by in the Washington Post:
Critics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.
Doctors prefer to live in affluent urban areas instead of rural poor ones. This is a surprise … why? Doctors are people. There are more people in urban and suburban areas than in rural ones. It’s, you know, part of the definition. Therefore, there are going to be more doctors where there are more people.
Sure, there are doctors who love the rural lifestyle. Hats off to them. However apparently, there aren’t enough of them. Then again, rural areas, by definition, have relatively few people scattered over a wide area. In order for doctors and patients to get together, someone’s going to have to travel. (Yes, there’s always telemedicine. Doesn’t help much when you need an actual procedure like surgery, or help delivering a baby. No matter how you cut it, there are times when you and your doctor need to be in physical contact.)
So obviously there are going to be more doctors where there are more people. But why might they cluster in affluent areas? Contrary to popular belief, lots of us feel strongly that everyone deserves medical care. Unfortunately, we are faced with the realities of making a living in a profession that requires a truly obscene upfront investment. I am personally aware of numerous students who would make fabulous primary care physicians who feel they won’t be able to pay off their loans unless they go into more lucrative specialty fields. I’ll bet that distribution problem would sort itself out in a hurry if we overhauled the financing of medical education.
Imagine what public transportation would look like if all the operators had to purchase and maintain their own vehicles, and if they all had total freedom about what routes and vehicles they were going to run? If I’m going to be forced to buy a bus, you’d better believe I’m going to choose the best paying routes in the nicest parts of town. Then again, why bother? How about if I just get a Mercedes limousine and limit my practice to shuttling rich folk back and forth wherever they wanted, almost like a “concierge”?
And no, nurse practitioners and physician assistants are not the answer either. I think that non-physician providers should care for healthy people and doctors should take care of sick people. Let the NPs do well-baby and preventive care until the cows come home. And in the second place, it’s just as hard to get NPs and PAs to set up shop in poor, rural areas as it is to attract doctors. Hell, most of them avoid primary care as well, and why? It doesn’t pay well enough. What a surprise.
Here’s a thought: Make medical school (college too) affordable to everyone qualified who wants to go. Then see what that physician distribution issue looks like in ten to fifteen years.
Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.