America’s million-doctor shortage is right around the corner

[Lucille]

Thanks to the AMA and government (https://mises.org/library/how-government-helped-create-coming-doctor-shortage).

http://www.marketwatch.com/story/americas-1-million-doctor-shortage-is-right-upon-us-2016-04-01


The doctor is disappearing in America.

And by most projections, it’s only going to get worse — the U.S. could lose as many as 1 million doctors by 2025, according to a Association of American Medical Colleges report.

Primary-care physicians will account for as much as one-third of that shortage, meaning the doctor you likely interact with most often is also becoming much more difficult to see.

Tasked with checkups and referring more complicated health problems to specialists, these doctors have the most consistent contact with a patient. But 65 million people live in what’s “essentially a primary-care desert,” said Phil Miller of the physician search firm Merritt Hawkins.

Without those doctors, our medical system is “putting out forest fires — just treating the patients when they get really sick,” said Dr. Richard Olds, the chief executive officer of the Caribbean medical school St. George’s University, who is attempting to use his institution’s resources to help alleviate the shortage.

Dr. Ramanathan Raju, CEO of public hospital system NYC Health + Hospitals, goes even further, saying the U.S. lacks a basic primary-care system. “I think we really killed primary care in this country,” said Raju. “It needs to be addressed yesterday.”...

[donnay]

They can thank the Insurance Co.'s and Obamacare.

[Intoxiklown]

My wife is a nurse practitioner, and the shortages are even more evident by virtue of her job description. Every year, they delegate more treatment options to mid level providers (Physician's Assistant and Nurse Practitioner), especially in an ER environment. My wife has got her DEA number a couple of years ago, and can write up to Class II (with the exception of weight loss drugs. Doctors didn't want to lose their Addipex clinics). And more and more, she is performing care and treatments that only a few years ago would have been unheardof anyone but an MD performing.

[Anti Federalist]

End the war on ALL drugs, and let people medicate themselves.

[Ender]

End the war on ALL drugs, and let people medicate themselves.

Yep- and get .gov OUT of the medical business.

[angelatc]

The pay disparities reflect America’s “fee for service” health-care model, which compensates providers based on the number and type of services they complete, and which inherently favors specialists.

Reform-minded critics say compensation should instead be based on the period of time a patient is cared for. They argue that this structure would incentivize preventative care and prevent unnecessary (and often costly) medical procedures. The Centers for Medicare and Medicaid Services is in the very early stages of considering this global payment model.


So they want to take away the premium that specialists command? And replace it with a flat rate that would encourage all of them to treat you endlessly?

Just, no.

[donnay]

Yep- and get .gov OUT of the medical business.

Absolutely. Free market and it would boom.

[amartin315]

primary care physicians are useless anyway. i'd much rather save myself the time and expense and just go straight to the specialist when i need him.

[oyarde]

My Dr retired this yr , I have the same flat rate cash price negotiated with his replacement for my annual physical which is all I go for . I should have tried for less now that I am retired .

[presence]

why?

reason is simple:

LICENSES, PRESCRIPTIONS, REGULATIONS

We'd be better off with a free market of quacks offering placebos.

[willwash]

Absolutely. Free market and it would boom.

You'd have to go all the way. If you got rid of the AMA's ability to limit the supply of doctors, you'd have to eliminate federal student loans as well. When there is no limit to the amount of money a student may borrow, nor to the number of students who may receive such federally guaranteed loans, it creates irresistable pressure on existing medical schools to enlarge their classes and for new medical schools to open up. Admissions standards decline, and the field becomes saturated, driving down wages to bare equilibrium with loan amounts. Eventually, medical school tuition is so high and wages are so low that doctors become a class of indentured servants to their student loans. Except, of course, those who go on military scholarships.

If you got rid of federal student loans, it'd fix a lot of these problems.

[Lucille]

More Doctors To Retire As MACRA And Value-Based Pay Hit
http://www.forbes.com/sites/brucejapsen/2016/09/21/more-doctors-to-retire-as-macra-and-value-based-pay-hit/#5752c0e24261


The nation’s doctors, facing a tsunami of changes in how they are paid, plan to retire in droves as value-based pay replaces fee-for-service medicine and they are forced to implement more new regulations, according to a new report.

The biennial survey from the Physicians Foundation shows 46% of physicians plan to “accelerate” their retirements, cut back on patients or seek “non-clinical roles,” according to the group’s survey, which is conducted by physician staffing and recruitment firm MerrittHawkins. More than 17,000 physicians are polled, Merritt said.

Not all of these doctors will leave medicine right away, with 14.4 % of physicians saying they will retire in the next one to three years compared to 9.4% in 2014. Meanwhile, 21% say they will cut back on hours and another 13.5% say they will seek a “non-clinical” job in healthcare.

Doctors are being dogged by “poor morale” and “invasive regulations,” according to the survey. This includes payment changes that are requiring physicians to be measured and earn reimbursement from insurers and government health programs based on health outcomes.

The nation’s doctors, facing a tsunami of changes in how they are paid, plan to retire in droves as value-based pay replaces fee-for-service medicine and they are forced to implement more new regulations, according to a new report.

The biennial survey from the Physicians Foundation shows 46% of physicians plan to “accelerate” their retirements, cut back on patients or seek “non-clinical roles,” according to the group’s survey, which is conducted by physician staffing and recruitment firm MerrittHawkins. More than 17,000 physicians are polled, Merritt said.

Not all of these doctors will leave medicine right away, with 14.4 % of physicians saying they will retire in the next one to three years compared to 9.4% in 2014. Meanwhile, 21% say they will cut back on hours and another 13.5% say they will seek a “non-clinical” job in healthcare.

Doctors are being dogged by “poor morale” and “invasive regulations,” according to the survey. This includes payment changes that are requiring physicians to be measured and earn reimbursement from insurers and government health programs based on health outcomes.

“Many physicians are dissatisfied with the current state of the medical practice environment and they are opting out of traditional patient care roles,” said Dr. Walker Ray, president of the Physicians Foundation, in a statement accompanying the report.

Insurers including Aetna AET +0.16%, Anthem WLP +%, UnitedHealth Group UNH +0.86% and Blue Cross and Blue Shield plans are shifting the bulk of their payments away from fee-for-service arrangements that reward volume of care delivered to value-based models that tie reimbursement to quality and outcomes. The Physicians Foundation survey showed 43% of physicians now say they have their pay tied to value-based models.

Doctors are uneasy about these payment changes and surprisingly in the dark about the biggest one to come when they face implementation of quality measures required under the Medicare Access and CHIP Reauthorization Act of 2015 known as “MACRA.” MACRA repealed the flawed sustainable growth rate (SGR) formula railed against by doctor groups for more than a decade because it cut Medicare payments to physicians.

MACRA is bringing merit-based incentive payments as the law shifts away from fee-for-service medicine. MACRA’s payment system brings together three existing reporting programs: the physician quality reporting system, the value-based payment modifier and meaningful use.

“Doctors have been on a slow boil over a variety of issues for years,” said Mark Smith, president of MerrittHawkins “Implementing value-based care and adjusting to MACRA on the fly has turned up the heat a few more degrees. The result is more than hard feelings.”