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Thread: America is running out of doctors.

  1. #1

    America is running out of doctors.

    http://reason.com/blog/2014/06/03/if...aybe-depending

    The fiasco at the Veterans Health Administration is only the tip of the iceberg; the United States is running out of doctors, and soon we'll all be begging for scraps of medical care, warns Marina Koren of the National Journal.

    The part about the physician shortage is probably true (though it assumes that the shape of the health care industry, and who provides care, is unchangeable). But that shortage is likely inevitable in a country that has come to depend on Uncle Sugar to foot the bill for graduate medical education (GME)—residencies—which has become a bottleneck now that the federal government is broke and in a lousy position to increase spending on anything.

    Writes Koren:

    America is running out of doctors. The country will be 91,500 physicians short of what it needs to treat patients by 2020, according to the Association of American Medical Colleges. By 2025, it will be short 130,600.

    Like at the Veterans Affairs Department, demand will be highest for primary-care physicians, the kinds of doctors many people go to first before they are referred to specialists.

    While students are applying to and enrolling in medical schools in record numbers, high interest does not necessarily mean more doctors. The number of residences—crucial stages of medical training—has not risen with the number of applicants, thanks to a government-imposed cap. The Association of American Medical Colleges has pushed Congress to change the law, predicting that there won't be enough residencies for young doctors by next year.
    Sure enough, the American Medical Association is waging a campaign to "SaveGME," which just means that it's lobbying for more federal bucks to subsidize residencies. As it is, the federal government places a cap on residency slots that it is willing to subsidize through Medicare and Medicaid. That's because the current process is expensive with "the public investment per physician in training comes to half a million dollars or more, according to HealthAffairs. Health insurance companies also subsidize residency slots with higher payments to teaching hospitals, but the feds are the biggest source of funding for GME.

    Note that in terms of physician training, this is the chokepoint. Medical schools are opening all over the place. But medical students pay for their education, while residents are paid, so everybody wants Uncle Sugar to pick up the tab.
    [...]
    The shortage is in primary care. Researchers find that "despite evidence tying access to primary care physicians to improved community health outcomes and decreased costs, medical student interest in primary care and, thus, medical school output of primary care physicians, has been declining."

    The researchers propose all sorts of schemes for coordinating care and cherrypicking potential students who would want to go into primary care, without asking why students might not choose to enter a field where they would seem to have guaranteed employment.

    But medical students aren't idiots. The realities of primary care, according to Dr. John Schuman, are "fifteen-minute visits with patients on multiple medications, oodles of paperwork that cause office docs to run a gauntlet just to get through their day, and more documentation and regulatory burdens than ever before."

    So new doctors make logical choices—many become subspecialists working for hospitals where somebody else fields the paperwork and the paychecks are regular.

    We have a shortage of primary care physicians largely caused by a bankrupt government that we've become dependent on to subsidize the education of primary care physicians. There just may be a common thread here.
    Based on the idea of natural rights, government secures those rights to the individual by strictly negative intervention, making justice costless and easy of access; and beyond that it does not go. The State, on the other hand, both in its genesis and by its primary intention, is purely anti-social. It is not based on the idea of natural rights, but on the idea that the individual has no rights except those that the State may provisionally grant him. It has always made justice costly and difficult of access, and has invariably held itself above justice and common morality whenever it could advantage itself by so doing.
    --Albert J. Nock



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  3. #2
    Ya mean subsidizing industry doesn't work? Ya don't say!
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  4. #3
    I hate to be selfish, but this has been great for my family. As I've said before, my wife is a nurse practitioner, and the current state of medicine is opening up more training and pay for her as responsibilities are transferred to mid level care givers such as practioners and physician assistants. We have been talking of her opening her own clinic soon, as right now she is only required to have an MD log four hours weekly in a clinic ran by a mid level. At this rate, she may not even need that soon.

    They've already changed the laws to allow her to to write up to level II narcotics.

    The good news she sees from this though, is you are looking at more clinics like she is talking of opening everywhere, translating into much more personalized care.

  5. #4
    Government creates a cap and creates a shortage. The next thing you will hear is that it is a job that Americans can't or won't do and that we need to import massive amounts of doctors from the second and third world.
    "Foreign aid is taking money from the poor people of a rich country, and giving it to the rich people of a poor country." - Ron Paul
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  6. #5
    Quote Originally Posted by Brian4Liberty View Post
    Government creates a cap and creates a shortage. The next thing you will hear is that it is a job that Americans can't or won't do and that we need to import massive amounts of doctors from the second and third world.
    Your crystal ball is running a little slow. Been hearing that for a while now.
    Quote Originally Posted by dannno View Post
    Lol, wow, Anthony Weiner, too?

  7. #6
    My doctor is a Ron Paul supporter. He and the other doctors in his practice intend to create a concierge practice. http://www.conciergedoctor.com/concierge-medicine

    That is - until the government makes it illegal. And I won't divulge what he intends to do when that happens.
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    If anything, this situation has proved the government is nothing but a dictatorship backed by deadly force... no different than the dictatorships in the banana republics, just more polished and cleverly propagandized.
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  8. #7
    Quote Originally Posted by Deborah K View Post
    My doctor is a Ron Paul supporter. He and the other doctors in his practice intend to create a concierge practice. http://www.conciergedoctor.com/concierge-medicine

    That is - until the government makes it illegal. And I won't divulge what he intends to do when that happens.
    Now I am curious as to what they intend on doing?? I go to a concierge practice as well which is so much more pleasant and personable than the norm. I am a dentist as well and the govt keeps saying there is a shortage of dentists even though many of my dentist friends are in urban areas stuggling to make a living due to high costs and maldistribution/surpluses of dentists. As far as healthcare is concerned, what we really have is a shortage of people who are willing to pay for any and all healthcare costs as the nation has been spoonfed that it is a right. The VA system is a perfect example of what is in store as we more closer to the bureaucratic dream of a single payer system. Actually, we'll wish we had something half as good as the VA and all its problems in 10-20 years. I am inclined to believe we'll see all the federal run BS come to a head and SHTF before a single payer system is ushered in by the leftests.

  9. #8
    Quote Originally Posted by Brian4Liberty View Post
    Government creates a cap and creates a shortage. The next thing you will hear is that it is a job that Americans can't or won't do and that we need to import massive amounts of doctors from the second and third world.
    Too late.
    Knowledge will forever govern ignorance; and a people who mean to be their own governors must arm themselves with the power which knowledge gives. -James Madison



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  11. #9
    That and the fact that China and India are using our liberal ideals against us. They send their best and brightest to our schools, especially medical/dental/pharma school, taking up spots that should go to Americans, then they take the skills they learn back home. These schools are almost all Asian. Many of them are Asian Americans, but a disturbingly high number are not, they are Asian Asians.
    I too have been a close observer of the doings of the Bank of the United States...When you won, you divided the profits amongst you, and when you lost, you charged it to the bank...You are a den of vipers and thieves. I have determined to rout you out, and by the Eternal, I will rout you out!

    Andrew Jackson, 1834

  12. #10
    Quote Originally Posted by Brian4Liberty View Post
    Government creates a cap and creates a shortage. The next thing you will hear is that it is a job that Americans can't or won't do and that we need to import massive amounts of doctors from the second and third world.
    The importation of massive numbers of physicians from the "second and third world" is the last thing that "the powers that be" in organized medicine (e.g., the AMA) will ever allow in this country. They have for years stymied efforts to open new medical schools and fought tooth and nail to suppress competition (by means of licensing laws, etc.) to keep the supply of doctors low and wages high. As of now, all physicians trained overseas have onerous hoops to jump through before they can legally practice medicine in the USA - they have to pass all 3 MD board exams (USMLE Step 1, Step 2, Step 3), receive letters of recommendation from American institutions, and successfully apply for an American residency program and complete it - this is basically a repeat of the entirety of medical education save for the first 2 preclinical years of medical school!

  13. #11
    Quote Originally Posted by willwash View Post
    That and the fact that China and India are using our liberal ideals against us. They send their best and brightest to our schools, especially medical/dental/pharma school, taking up spots that should go to Americans, then they take the skills they learn back home.
    Can you provide a source for these ideas? Some of what you described better fits undergrad where colleges/universities seem to gladly take international students since they tend to pay tuition upfront.

    Quote Originally Posted by willwash View Post
    These schools are almost all Asian.
    This statement is more true for undergrad state systems like the University of California schools that have eliminated affirmative action in admissions and end up with student bodies that have an Asian plurality (~40%). Med schools on the other hand, still take race into account in admissions and NEVER end up with a plurality Asian student population.

    Quote Originally Posted by willwash View Post
    Many of them are Asian Americans, but a disturbingly high number are not, they are Asian Asians.
    As for international students, it's extremely difficult for them to gain admission to American med schools, period. The overwhelming majority of those "Asian Asians" in med schools that you're referring to are Americans, period.

  14. #12
    Quote Originally Posted by Intoxiklown View Post
    I hate to be selfish, but this has been great for my family. As I've said before, my wife is a nurse practitioner, and the current state of medicine is opening up more training and pay for her as responsibilities are transferred to mid level care givers such as practioners and physician assistants. We have been talking of her opening her own clinic soon, as right now she is only required to have an MD log four hours weekly in a clinic ran by a mid level. At this rate, she may not even need that soon.

    They've already changed the laws to allow her to to write up to level II narcotics.

    The good news she sees from this though, is you are looking at more clinics like she is talking of opening everywhere, translating into much more personalized care.
    That does sound like a really good business opportunity!
    I have an autographed copy of Revolution: A Manifesto for sale. Mint condition, inquire within. (I don't sign in often, so please allow plenty of time for a response)



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