Will universal healthcare lead to a doctor shortage?

[razorman]

I am concerned that, in spite of all the problems it would correct, the president's health care plan will lead to a great shortage of physicians. If so, this would definitely cause rationing of health services. Do any other DU'ers have any info that might alleviate my concerns? The reason I ask this is that I personally know three doctors(one of them my own doc, and another my dentist), all of them in their early-to-mid 50's, who say that if national health care passes, they will take early retirement. They believe their hands will be tied professionally, and their incomes will be regulated.
What do you folks think?

[lumberjack_jeff]

1. Are doctors like oil?

A non-renewable resource? Are we heading for peak-med?

Or maybe, oh, I dunno, we could train more?

I'm finding all the bogus reasons to not reform healthcare pretty vexing.

[razorman]

6. I have wondered that, too. I have heard that the AMA controls the number of new doctors

that enter the profession. I don't know how true that is. Hopefully, there will still be enough bright young people who will not be scared off by the propaganda, and still want to become physicians.

[SharonAnn]

29. Yes, they want to limit the number of doctors to keep rates high.

We have been graduating too few doctors for quite a while now.

That could be changed, we have plenty of qualified applicants for medical school here in the United States. We just have too few slots for them.

My father was a surgeon, my whole family is medical, and I've been following this issue for about 50 years.

[ingac70]

35. Becoming a doctor cost too damn much.

That's is why there is too few doctors.

[ingac70]

33. Only 25% of doctors belong to the AMA. n/t

[DailyGrind51]

50. This is true, along with the amount of federal capitation funds going to medical schools.

The federal government could make its capitation money contingent on recipients schools expanding enrollment.

[sinkingfeeling]

2. I'd say we'd fill any shortage via H1B vistas.

[abumbyanyothername]

37. Visas

But this would also help soak up the housing glut. :-)

[sinkingfeeling]

47. Thanks. DU and I were having some problems this morning.

[endarkenment]

I think that is nonsense.

On the other hand, real national health care reform would result in a severe shortage of insurance companies skimming 30% off the top.

[OHdem10]

3. Some will retire. Others will take their place.

They have done quite well financially to be able to retire
in their 50s. Their interest is money?????

[razorman]

25. Not entirely. At least I don't believe so.

They are good people. In talking to them, I gather that they mainly fear government control and that the medical profession is going to become some DMV-like monstrosity. Also, while the doctors I am speaking about are doing well, I believe they have all lost money in the current recession, so I am not sure how able they actually are to carry out their threat of early retirement. They may just be blowing off steam.

[Mojorabbit]

42. My hubby is a family doc

and is hoping for single payer. He can't do his job well with things the way they are now. It does no good to prescribe a med if the person can't pay for it. He needs to have diagnostic tests to make a good diagnosis but if the person can't pay for the test.... and so on. We kick in some help when we can to people who are in desperate straits but it is a drop in the bucket. He wants to do his job and he can't.

To top it off, his policy canceled him over ten years ago after he had a small heart attack. He has been healthy since but no one will insure him at any price. It is personal to us. The system sucks.

That being said, if there is a rush of millions of newly insured people looking to be seen in a short time frame, there will be a severe shortage of access as there are not enough physicians right now to cover them all. It think it will all shake out in time.

[cushla_machree]

62. My doctor thinks the opposite

He hates how the insurance companies are dictating how he practices medicine. He would love to cut the 100+ insurance plans he has to deal with down to one, with clear terms on what is covered and what is not.

[supernova]

4. There is an artificial restriction

of minting doctors anyway. Medical schools are very restricted (by the AMA?) in how many places they can offer.

And we need many more GPs than we have now. Too many people are going into lucrative specialties so that they can repay their medical school loans. We need to talk about how we fund medical education so that anyone, regardless of resources, who is qualified and wants to become a doctor, can afford to do so.

Also, distribution is a problem. Certain rural and urban areas are underserved, while more affluent areas are overrun in certain disciplines.

[dugaresa]

12. i just posted about this restriction process

I think that may be part of the problem.

Problem with GP's is that they make on average $130K per year and yet they may have as much as $500K in debt when they get out of school. Sadly it makes sense as to why they go into specialities. Hell even the specialists have a hard time and the start up costs for starting a practice are high along with insurance.

The "groups" of physicians pool resources but even in those cases they have problems.

[razorman]

18. Good points. I don't envy the president having to solve these problems.

We have to keep in mind that when his plan is enacted, the 47 million uninsured will enter the new system. I hope all this is being thought out thoroughly, and plans being made to reinforce the ranks of medical professionals. However it is handled, though, it won't happen overnight.

[supernova]

32. No, it won't happen overnight

It will take years to fully implement.

But we will be better off in the long run, both as patients, and as medical professionals. Most doctors I know just want to do the science and take care of their patients, but not have to fight insurance companies at every turn.

But we do need a public option that WILL NOT be profit driven. That is the only way to tame the insurance companies and keep it a "free-market" system. I fear this will not happen.

[sinkingfeeling]

5. Duplicate post because DU said it'd lost my cookie, but it lied.

[dugaresa]

7. I heard a rumor years ago that the AMA and the medical schools keep

the number of doctors at a level that guarantees their higher salaries and justifies the costs of medical school.

(the guy who told me this rumor worked for a medical school)

Medical schools have very limited admittance whereas other professional schools aren't as restrictive.

I can't remember the conversation in its entirety but I have known some really talented people who had a rough time being accepted into medical school. They had the grades, the talent, etc but there were limited slots so it made this guy's story a bit believable.

Today I wonder more about this. What if the medical schools were to double their acceptance or say triple it? That would put a lot more doctors out into the market in a few years. More competition, isn't that supposed to be good for us as consumers?

[SharonAnn]

30. Yes, they limit the slots to keep doctors' rates high. There's plenty of talent, not enough slots

[Dr_Willie_Feelgood]

8. Boo Hoo!

Perhaps they need to drive a Chevy instead of a Caddy, or a Toyota instead of a Lexus! I doubt if the pay will drop much, if at all. But they are buying into the RW spin machine.

There are medical professionals from around the world willing to come here to take their greedy place.

[spanone]

9. perhaps it will weed out the doctors who are only in it for the money

[CountAllVotes]

16. I hope it does

and yes, there are plenty of doctors that go into medicine for one thing and that is money.

Greed works well for these freaks.

Perhaps weeding them out is a great benefit!

:kick:

[razorman]

28. I certainly understand that sentiment. But I am less concerned with

with a doctor's motives or empathy than I am with whether he or she is competent and can fix whatever I am suffering from at the time. If they can make me feel better, I don't care if they smile at me or not.

[supernova]

41. Actually, there is a difference

Doctors who are profit/prestige driven are less likely to figure out your problem. or perhaps mercifully, send you on to someone else who can. They don't have the drive or capacity for creative problem-solving, not to mention much less likely to help you with the emotional toll.

Even a brilliant curmudgeon like House, and I have known people like this, has a wonderful rapport with his patients. (Not that I endorse the opiate habit!!)

Good doctors are driven by wanting to be of service and by a love of science. They do it because that's who they are, not because they just want a paycheck and a standing tee time at the club.

[ejpoeta]

10. first of all, we already have a migration of doctors away from being doctors

and it has everything to do with the hassles of trying to practice medicine in this country. they spend so much time fighting with insurance companies to try to get paid, they don't get much time to be doctors. my doctor, for instance, seems to have a very large list of patients to see every day.... and you are lucky if you get five minutes of her time.... why??? probably just so she can stay afloat. universal healthcare won't hurt that!! if anything maybe it would help keep doctors being doctors.

[Bluenorthwest]

39. So what do they do instead?

If we already have them leaving the profession for more lucrative fields, what are those fields. My doctor wants the Insurance Companies out of it, and says she makes a great living.
I have had other doctors, and dentists, who fill their office with Conde Naste Traveller magazines and books about yachting, and those folks were clearly making bank. My last periodontist charged me $1500 for a service I later found could be had for $450, and he retired before the last appointment was done, forwarding to me and the rest of his clients a lovely postcard of his lavish ranch, with a note that they'd be keeping their home in town as well. It was heart warming behavior. Made me love the profession, and made me certain they are underpaid and will rush to more money if we look at them cross eyed.

[mainer]

44. True. I know half a dozen who've left medicine because of the stress.

And not always for more lucrative options. Can you blame them? Who wants 60-hour work weeks and night call? Many opt for a simpler life.

[Dr_Willie_Feelgood]

54. With the kind of bank they are making?

I wish I only had a 60 hour week!

As a cab driver I have 72+ hour weeks (12 hours x 6 days a week - on call 24x7) and only average, after fuel, SS and taxes, about $250 a week in profit!

Yes they need a lot more training than what I do. But still, I have a lot of pressure to keep my passengers and the public safe.

NO ONE needs to make more than two grand a week! Thats a hundred frickin thousand dollars a year!

[mainer]

56. Even with the money, it's not worth it to some of them

And many of those who are close to retirement age anyway are looking for any excuse to retire now.

But I have to admit, none of the doctors who've left are driving taxicabs. That sounds like a truly exhausting job.

[ThomWV]

11. Only the AMA can create a Doctor shortage, there are plenty of qualified applicants

And even if annual salaries come down to a few hundred thousand a year there will continue to be plenty of applicants.

[supernova]

15. I don't think MDs in UHC countries

are hurting.

They make a very nice living.

edit: Plus, they get the added benefit of NOT dealing with the insurance assholes second-guessing their treatment decisions and fighting with them about it.

[Johonny]

27. I agree

If the US find it has a doctor shortage no doubt it will easily solve it by offering to pay for med school and threatening the AMA with government take over of the training and certification process.

Anyways the whole thing is fake. Would people retire early if single payer passed... no. Maybe a few really dumb ones. But since it would hardly make much of a difference to most practices and since it allows them to have more paying costumers,and allow the cutting of their overhead may would make more money. As a general rule in life I find people that make money in general don't like to stop making money.

[PVnRT]

13. No

If those doctors retire who hate national health care, so be it. Plenty more will be waiting to take their place.

[Warpy]

14. I don't believe retirement will last long

because medicine is their identity, not just a livelihood. Most docs continue a limited practice past retirement age just because they're docs.

I would imagine these are the old GOP docs having a hissy fit because things might change again. After all, nothing has tied their hands or curtailed their incomes like for profit health care.

[livetohike]

17. Why do Americans who want to be doctors have to get trained

outside of the U.S.? There is the first problem: Open up the medical schools, increase attendance and allow US citizens who want to be physicians the luxury of receiving their education here in America.

[Lex]

19. Maybe a shortage of millionaire old white guy doctors.

There will be plenty of people who are very smart and want to be doctors even if a national health care plan passes.

[emsimon33]

20. People are currently receiving services, but many can't pay

The result is that everyone with insurance pays for the uninsured. Also, we don't ALWAYS need to see a doctor. Many HMOs use a triage approach using other health professionals.

[supernova]

21. Thanks for your "concern"

but honestly, since you told me that about you doctor "friends", they are exactly the type of MD I purposefully stay away from.

[Joanne98]

22. In-sourcing. They do it for everything else.

[qb]

23. If there is a shortage it would pale compared to the current shortage of accessible health care.

[Hello_Kitty]

24. Any plan ought to include funding to recruit and train physicians and nurses

Full forgiveness for medical school debt if you go into GP or work in an underserved area.

The current system has already led to a shortage of physicians, since so many of them get tired of haggling with insurance companies.

[kjackson227]

26. There's already a shortage of PCP's and nurses too...

but just in case this is more fear mongering to further disrupt the progress of public option, President Obama has a proposal to help decrease the shortage of doctors and nurses. See it here...

http://www.hrsonline.org/Policy/LegislationTakeAction/obama_speech_ama.cfm

Folks, the fear mongering has got to stop, and it really isn't that hard to research and find answers to questions regarding the healthcare reform (public option) proposals that is if you have doubts, and really want to know.

[ingac70]

31. Universal healthcare isn't on the table....

universal insurance is.

[kath]

43. That's right - anyone who thinks we're going to get universal health CARE is dreaming -

this mandatory insurance stuff is *bullshit*.

[abumbyanyothername]

34. More medical schools.

Also, not for profit healthcare would likely actually result in healthier people, as the payor could align the physician incentives with healthy patients, rather than sick ones.

[Vincardog]

36. So your doctors Will retire and make no income for fear of income possible regulations? Sound like

they must be rePUKES to me.

[elehhhhna]

48. sounds like Joe The Doctor

[Vincardog]

53. EGGZactly. Where are their Papers? Are They AmeriKKKan Doctors? Inquiring minds want to kkknow

[PDJane]

38. We had that argument here, before universal care

was implemented. As it stands, more doctors here are in private practice than there, and incomes went up an average of $5,000 per year after the implementation of universal care. It's a red herring. Government run health care is easier for doctors; they submit a bill, the government pays it. The cost of operating a public insurance plan is about 4%, instead of the 30% for private insurers, and that includes the doctor's staff.

Rationing is a kind of red herring too. That doesn't happen either; there are wait times for elective procedures, but there isn't rationing.

[LiberalAndProud]

40. We ration here, based on ability to pay.

So I don't worry much for the rationing argument.

[PDJane]

57. Actually, some of the more honest opponents of

universal health care have stated, quite bluntly, that they're afraid, since there is a shortage of doctors and such, that they don't want to have to share what there is with the great unwashed masses. They don't actually put it that way, but that's what the whole argument boils down to.

[mainer]

45. Starting a medical school is hideously expensive

The shortage of M.D.'s isn't entirely due to AMA control. Some of it has to do with how much it costs to get a med school started. We'd love to have one up here in Maine (we do have an osteopathic school) but there's no money to get it off the ground.

[mainer]

46. We already have a doctor shortage

Depending on where you live in the country, you may not be anywhere near a doctor. And there's definitely a shortage of docs in primary care and geriatrics.

[Horse with no Name]

49. I hate to break this news to you

but there is ALREADY a shortage of physicians...which makes me believe it is one of the reasons the "insured class" is so reluctant to embrace sharing their doctor with one of the unwashed uninsured.

http://www.managedcaremag.com/archives/0706/0706.shortage.html
>>>snip

[timeforpeace]

51. Don't think so, no.

[Maru Kitteh]

52. I think the physicians you know suffer from recto-cranial inversion.

I think more physicians would be willing to enter practice as GP's if they knew the medical school debt would be relieved and they knew they would be able to actually practice medicine. Obama has been working on both of those points. Right now 1 in 5 American workers has NO HEALTH CARE.

If your physician does not care about those people to poor to make it through his door and is too stupid to realize his income is already regulated by the insurance companies then you need to drop that bastard like a hot rock.

Your doctor is a dumbass. So is your dentist. So is the other doctor you know.

You are surrounded by dumbasses. How did that happen?

[bobbolink]

55. The ridiculous cost of medical education is what is causing the loss of doctors.

Other countries have free health care (yes, I know....sigh..) and free education.

Their doctors don't graduate with ridiculous debt.

But,, then, that would cause us to be human.

[andym]

58. Actually current trends are leading to a primary care doctor shortage

So many of those studying medicine want to specialize that there is already a shortage of primary care physicians that is bound to increase. This has to do with both increased pay and prestige accorded specialists. This is a serious problem that is independent of health care reform.

[kenny blankenship]

59. You know some dumb motherfuckers then

Who would rather have no income from their trade than a regulated income. Not that these Doomsday scenarios that they project have any chance of realization.

Yeah, I'll just cut my income to ZERO and live by my wits outsmarting the stock market! That'll show 'em!

There's a chance that your doctor friends mean exactly what they say, and there's also an excellent chance that they're just talking out of their butts.

[area51]

60. How about ...

... we end the two wars of choice, free up that money being spent on them, use it start the transition to single-payer, and use it to offer free training in healthcare professions to the soldiers coming home. :think:

[LiberalAndProud]

61. I suspect that they are speaking out of political passion.

Repulicans (all 3), I'd be willing to bet. After this health care bill passes, (and I believe it will pass) they will realize that the sky has not fallen and that they have not been robbed. They will continue to see their patients, making a comfortable living, all the while grousing about the next tremor beneath their Solid Ground Status Quo.

They will be fine. And America will be better.

If the Republicans had passed Nixon's health plan in 1974, their party could have framed the outcome. They missed their chance.


it is time. it is past time.

[Hekate]

63. You mean we'll have to share? Or you mean there'll be an exodus of dinosaurs?

Their incomes will be more regulated, so they will forego those earnings altogether and do what? Retire on their assets? Those kinds are out of my price range anyway.

I "lost" my GYN a couple of years ago when she dropped Blue Cross due to the aggravation of dealing with them. So did the radiologist who used to do my mammograms. Fortunately for me I have other options in this town -- but paying up front for my medical care when I already pay through the nose for Blue Cross is not one of them.

I think there are doctors (and dentists) in the US who are still drinking the corporate Kool-ade, but I don't think there will be a genuine shortage of medical practitioners. We'll probably hire more from foreign countries to take up the slack, just as we do now with nurses.

Hekate

[MrsBrady]

64. there's already a shortage.

Seems to me, though, if more people could AFFORD their services, they would be working more.

Perhaps they don't want more customers.(sarcasm)...i mean, patients.

[slipslidingaway]

65. Other reasons...

http://www.eurekalert.org/pub_releases/2009-03/acop-uep032409.php

"...The reasons behind the decline in the supply of primary care physicians are multi-faceted and complex, Dr. Harris added. They include the rapid rise in medical education debt, decreased income potential for primary care physicians, failed payment policies, and increased burdens associated with the practice of primary care..."

[Odin2005]

66. The shortage is manufactured by the AMA