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Not enough doctors under Obamacare





jmi256
The consequences of Obamacare are becoming more and more evident as an already strained system will be strained even further, leading to longer wait times and less care provided by PCPs and more by less-trained staff. As predicted there will not be enough doctors to support the Democrats' 'plan' for government-run healthcare. Can anyone say rationed care?

Quote:
Medical Schools Can't Keep Up
As Ranks of Insured Expand, Nation Faces Shortage of 150,000 Doctors in 15 Years


The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

A shortage of primary-care and other physicians could mean more-limited access to health care and longer wait times for patients.

Proponents of the new health-care law say it does attempt to address the physician shortage. The law offers sweeteners to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

Meanwhile, a number of new medical schools have opened around the country recently. As of last October, four new medical schools enrolled a total of about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

But medical colleges and hospitals warn that these efforts will hit a big bottleneck: There is a shortage of medical resident positions. The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.

Doctors' groups and medical schools had hoped that the new health-care law, passed in March, would increase the number of funded residency slots, but such a provision didn't make it into the final bill.

"It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.


While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S.

One provision in the law attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary-care or general-surgery residencies. The slot redistribution, in effect, will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.

Some efforts by educators are focused on boosting the number of primary-care doctors. The University of Arkansas for Medical Sciences anticipates the state will need 350 more primary-care doctors in the next five years. So it raised its class size by 24 students last year, beyond the 150 previous annual admissions.

In addition, the university opened a satellite medical campus in Fayetteville to give six third-year students additional clinical-training opportunities, said Richard Wheeler, executive associate dean for academic affairs. The school asks students to commit to entering rural medicine, and the school has 73 people in the program.

"We've tried to make sure the attitude of students going into primary care has changed," said Dr. Wheeler. "To make sure primary care is a respected specialty to go into."

Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine in New York, has 1,220 residency slots. Since the 1970s, Montefiore has encouraged residents to work a few days a week in community clinics in New York's Bronx borough, where about 64 Montefiore residents a year care for pregnant women, deliver children and provide vaccines. There has been a slight increase in the number of residents who ask to join the program, said Peter Selwyn, chairman of Montefiore's department of family and social medicine.

One is Justin Sanders, a 2007 graduate of the University of Vermont College of Medicine who is a second-year resident at Montefiore. In recent weeks, he has been caring for children he helped deliver. He said more doctors are needed in his area, but acknowledged that "primary-care residencies are not in the sexier end. A lot of these [specialty] fields are a lot sexier to students with high debt burdens."




Source = http://online.wsj.com/article/SB10001424052702304506904575180331528424238.html?mod=WSJ_hpp_MIDDLENexttoWhatsNewsSecond
coolclay
Quite an interesting repercussion that I had not previously considered. But theoretically speaking however even if people are insured I don't quiet understand while there would need to be such an additional number of doctors. Even in the past when I haven't been insured if I had a medical problem I would still have to go to the doctor, I would just have to pay are larger amount. Even once insured people would still have a copay to visit the doctor, so I don't think that many more people would go to the dr's vs. those that are uninsured. If your injured/sick your injured/sick, whether or not your insured doesn't really make a difference unless, the injury or sickness doesn't really warrant a dr's visit in the first place.
ocalhoun
coolclay wrote:
Quite an interesting repercussion that I had not previously considered. But theoretically speaking however even if people are insured I don't quiet understand while there would need to be such an additional number of doctors. Even in the past when I haven't been insured if I had a medical problem I would still have to go to the doctor, I would just have to pay are larger amount. Even once insured people would still have a copay to visit the doctor, so I don't think that many more people would go to the dr's vs. those that are uninsured. If your injured/sick your injured/sick, whether or not your insured doesn't really make a difference unless, the injury or sickness doesn't really warrant a dr's visit in the first place.

There are differences in what people would go in for though...

If an uninsured person starts having back pain, he'll probably decide to wait and see if it goes away on its own (partly because of the expense of getting it looked at).
An insured person would be much more likely to visit the doctor to have the back pain diagnosed.
Bikerman
ocalhoun wrote:
If an uninsured person starts having back pain, he'll probably decide to wait and see if it goes away on its own (partly because of the expense of getting it looked at).
An insured person would be much more likely to visit the doctor to have the back pain diagnosed.
Although that sounds logical I don't think it is.
Experience here is that few people 'over-use' the health service. What you should also remember is that visiting a doctor when symptoms first present will often save doctors time, not cost it, since waiting can lead to further complications which then require much more intervention.
ocalhoun
Bikerman wrote:
ocalhoun wrote:
If an uninsured person starts having back pain, he'll probably decide to wait and see if it goes away on its own (partly because of the expense of getting it looked at).
An insured person would be much more likely to visit the doctor to have the back pain diagnosed.
Although that sounds logical I don't think it is.
Experience here is that few people 'over-use' the health service. What you should also remember is that visiting a doctor when symptoms first present will often save doctors time, not cost it, since waiting can lead to further complications which then require much more intervention.

I don't mean that over-use of the system will be prevalent; just that under-use will become less common.

Let's say you have chronic heartburn...
If you have to directly pay for all visits to the doctor and all medication, you're more likely to just take antacids a lot and go on with your life.
If somebody else pays for most of it though, you're more likely to eventually go to the doctor and get diagnosed with acid reflux or something, and prescribed medication.
Bikerman
ocalhoun wrote:
Let's say you have chronic heartburn...
If you have to directly pay for all visits to the doctor and all medication, you're more likely to just take antacids a lot and go on with your life.
If somebody else pays for most of it though, you're more likely to eventually go to the doctor and get diagnosed with acid reflux or something, and prescribed medication.

That is a good example.
IF you have chronic heartburn then it is quite likely to indicate deeper pathology - sometimes reflux, sometimes serious heart problems. Reflux is not something to be taken lightly - we have a history in my family and it can kill you, slowly.
If you only go once in a while when you have the money, the doctor will not have a good patient record and will therefore not know how serious it could be.
Then, months or years later, the patient presents with serious gastero-intestinal damage or heart failure and requires intensive care and nursing for possibly the rest of his life. Roughly 20,000 for the initial treatment and stabilisation, then several thousand per week thereafter...
All for the sake of a few visits to the doctor....
Now, how does that make any commercial sense? And it isn't a one-off cherry-picked example, I promise you.
deanhills
ocalhoun wrote:
An insured person would be much more likely to visit the doctor to have the back pain diagnosed.
This is an excellent point. I am in a country in the Middle East where they went from almost no health insurance to compulsory health insurance for all. The waiting rooms have been packed since everyone went on health insurance. What seems to be abused most (in my mind anyway) are the medical tests. Ordinarily doctors would be selective when it came to testing, as they would be sensitive to the patient's final medical bill, but now there is no problem of course, as the patient is not paying for the tests. And like Ocalhoun said, patients previously would have waited out their symptoms, yet now it is really easy to go to the nearby clinic for any aches, pains and sniffles. And of course, there are still the same number of doctors around, who have to work with virtual production lines. Obviously with negative consequences for individual care. Previously they would have been much more careful with taking case histories, as they had longer time per consultation of patients, but now have much less time available.
Bikerman
Do you seriously think that the US can be compared to the middle east in any way relevant (ie social, medical, societal, historical, clinical, epidemiological)? Of course it can't. Attitudes and expectations are completely different for most of the population.
A better comparison is with those western countries that are as developed and have national health systems such as Canada, the UK, France...in fact just about ALL of them.
deanhills
Bikerman wrote:
Do you seriously think that the US can be compared to the middle east in any way relevant (ie social, medical, societal, historical, clinical, epidemiological)? Of course it can't. Attitudes and expectations are completely different for most of the population.
A better comparison is with those western countries that are as developed and have national health systems such as Canada, the UK, France...in fact just about ALL of them.
Actually Bikerman, systems here in the Middle East are designed by experts from Canada and the US. The local population is in a minority here in the Middle East. The majority of those who have medical insurance are expats. The majority of doctors here are expats. Yes, attitudes and beliefs are different, but the needs are basically the same. When people get something "for free" they may use it past its max. That is quite a human thing to do that is most certainly not limited to the Middle East.

I also think there is a huge difference in attitudes of those using the NHS system in the UK and the Health Insurance system in Canada. Even in the UK there are different sentiments. Some like you think it is a good system, others disagree.
Bikerman
That is all completely irrelevant to the subject at hand. I don't care who designed the system and how many expats use it - it doesn't change a thing. It is not a good comparator - and your description merely serves to indicate how BAD a comparator it actually is.

Simple question - which is the closer comparison with America, in terms of social attitudes, life expectancy, earnings, population demographics, medical and social expectations etc - the UK or a middle Eastern state such as Saudi Arabia?
It doesn't require a lot of research or a lot of thinking to answer that one, does it?
Now, if you are going to compare, then why not choose the more similar?

And don't start on about UK people feeling dissatisfied with the NHS. Yes, EVERYONE is dissatisfied with their system of health (and anything else, come to that) - they always are. No system can please everyone, and people just naturally like to moan. The point is that NOBODY* would propose changing to a US-style system because it is a no-brainer. Even the Tory party dare not propose major changes to the NHS because they KNOW they would loose the election - that is why the Tory party are currently trying to position themselves as bigger supporters of the NHS than the Labour party. When you say there are different 'sentiments' you forget to add that those sentiments are almost universally AGAINST tampering with the core principles of the National Health Service. Of course I have told you this before, in detail, with figures examples, quotes and statistics, but as usual you conveniently ignore or forget anything which you don't want to acknowledge and simply repeat the same old stuff as if it were credible. You do this time and again in threads and then wonder why people get frustrated and angry with you.
Ocalhoun makes a reasonable point which I counter reasonably. The scene is set for agreement or continued debate on the matter. I wait for him to consider and continue, but what happens? Dean buts-in with one of his irrelevant side-tracks, and suddenly we are talking about Saudi bleedin arabia, or the UAE whatever.

It is infuriating!
I make a conscious effort not to post when you are discussing a specific point with someone else within a thread, unless there is an inaccuracy - not because it is against the rules but because it is bad netiquette. Please consider doing the same, that way the point can be finished, I can go away, and you can post anything you like.

I do not intervene as a poster much - because as I frequently point out, I don't have any axe to grind about what Americans choose to do via health provision. When I do join in it is normally because someone has made a comparison with the UK or with our type of provision that I find inaccurate, misleading, or downright silly. You are free to disagree of course, but you should bear in mind that I do know what I'm talking about and I do the necessary background research to check accuracy.

I will now exit and let you gentlemen continue.

* With the possible exceptions of a couple of loony right wing Torys who dare not suggest it here and, instead, do so from a very safe distance.
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