Monday, August 20, 2018

The Coming Doctor Shortage

I haven’t read too much about this, so maybe you haven’t either. It’s the looming doctor shortage. America is running out of physicians. Fewer students want to study medicine and more experienced physicians are leaving the field. It's nice to make political noise about how the government should provide medical care for everyone. It's not as nice to notice that there are not enough physicians to provide it. And that the more the government gets involved the fewer physicians want to practice medicien.

NBC News opens its report by explaining how wonderful it is to be a physician:

However, becoming a doctor remains one of the most challenging career paths you can embark upon. It requires extensive (and expensive) schooling followed by intensive residencies before you’re fully on your feet. The idea, generally, is that all the hard work will pay off not only financially, but also in terms of job satisfaction and work-life balance; then there’s the immeasurable personal benefits of helping people, and possibly even saving lives. In terms of both nobility and prestige, few occupations rank so highly.

And yet, it continues:

So why is there a waning interest to grow a career as a physician? A recent report from the Association of American Medical Colleges projected a shortage of between 42,600 and 121,300 physicians by 2030, up from its 2017 projected shortage of 40,800 to 104,900 doctors.

Naturally, we all want to know why this is happening. So does NBC News. It begins with the simple fact that college students seem more drawn to STEM jobs. They pay better; require less training; and allow people to live in more desirable locations:

There appear to be two main factors driving this anticipated doctor drought, as it were: Firstly, young people are becoming less interested in pursuing medical careers with the rise of STEM jobs, a shift that Craig Fowler, regional VP of The Medicus Firm, a national physician search and consulting agency based in Dallas, has noticed.
“There are definitely fewer people going to [med school] and more going into careers like engineering,” Fowler told NBC News.

Fowler also speaks to the desire among millennials to be in hip, urban locations — a luxury you likely won’t get when you’re fresh out of medical school and in need of a residency.

Apparently, there is also a shortage of residencies across the nation.

We also point out that STEM jobs have a greater concentration of males than do medical jobs. Of late, medicine has attracted more and more women. Traditionally, professions that become women’s professions lose status and prestige. And see lower wages. Young men tend to avoid them. This already applies to veterinary medicine and to psychotherapy. Why would we not see it in the medical field?

Recent medical school grads have difficulty finding residencies-- there are not enough-- and this produces a bottleneck effect.

Bureaucratic requirements, imposed on physicians by legislation and by insurance companies have pushed physicians out of the profession. I myself have heard from physicians that in order to keep the required records, they would have had to hire another staff member… thus making it too expensive to practice.

This “bottleneck effect” doesn’t usually sour grads on staying the course, Fowler finds, but he does see plenty of doctors in the later stages of their careers hang up their stethoscopes earlier than expected. Some cite electronic health records (EHRs) as part of the reason — especially old school doctors who don’t pride themselves on their computer skills. New research by Stanford Medicine, conducted by The Harris Poll, found that 59 percent think EHRs "need a complete overhaul;" while 40 percent see "more challenges with EHRs than benefits."

Dr. Amy Baxter explained why she was leaving medicine:

“I began to feel like an easily replaceable cog in the healthcare machine. With the [enforcement] of EHRs, I had to spend more time as a scribe. One night a child I was treating had a seizure and I couldn’t get the medicine to enable them to breathe because their chart wasn’t in the system yet. This kid was fixing to die and I, the doctor, couldn’t get the medicine. It was demoralizing.”

Bureaucratic regulations, whether imposed by the government or by insurance companies, make it more difficult to practice medicine. The same is true of other businesses.

One also adds that the sole practitioner model is going out of style. Young physicians who want hospital admitting privileges are obliged to work for hospitals. They cannot open a private practice. If they prefer independence to staff jobs, they are more likely to walk away from the field.


dirtyjobsguy said...

I've got a business partner with two sons in medicine (one practicing and one in medical school). The grind for men (particular white men) to get into med school is awful. There are a large number of applicants with more than sufficient qualifications that do not make it. If the Osteopaths hadn't expanded their schools the whole internist/GP field would have collapsed.

I think the close regulation of medical doctor training (and cartelization) has failed. The traditional individual or small group practice was given away by MD's in exchange for accepting Medicare as currently structured. This was a major disaster. I compare this closely with my dentist and veterinarians. They sell value and personal service along with flexibility. My Vet is a highly trained professional and over the years our dogs have seen specialists from surgeons, neurologists and oncologists. Yet we are always able to get appointments on short notice, speak directly to the Vet and be treated well. When one of our dogs had major surgery followed by a repeat operation, I was called after she came home by three of her vets to followup! Not nurses, not PA's, not clerks.

My vet also used old fashioned paper records. He could flip through a decade's worth of health information in minutes and get a full picture. The difference between him and my general physician is control. He runs his shop.

JPL17 said...

dirtyjobsguy: Shhhhhh!!! Don't give the Democrats any ideas. Otherwise they'll be introducing legislation for Obamadentalcare and Obamaveterinarycare, which of course will make it unaffordable and/or impossible to find anyone to fix your teeth or pets ….

I speak from experience. I've now lost *both* of my last 2 family doctors thanks to Obamacare -- and over a period of only 4 years! Both left private practice because they couldn't stand the Feds' overbearing control over their practices. So someone please tell the Democrats to "Stop helping".

Sam L. said...


Anonymous said...

ed in texas

One of my nephews recently finished his residency; same med school (BCoM), internship, and residency), and became the youngest member of the college faculty. But then, he's a DNA researcher, and already has half a dozen patents.
Oldest son's father in law is a thoracic surgeon; when Obamacare peeked over the horizon, he liquidated his equity in two hospitals, sold his practice, and, no not retired, moved to another state and now works only as a consultant and contractor.

JPL17 said...

Sam, make that about 5,000,000 voices! That's closer to the number of independent contractors whose rates tripled under Obamacare, for which they got worthless coverage because of the sky-high deductibles!