http://www.wsj.com/articles/SB1000142412...1780608174
This has been the subject of much discussion in other threads so I thought I would create a thread for it. The above WSJ article offers some good possible solutions. Like most problems there appears to be no one solution, but instead several approaches that need to be taken. Here are four that make sense to me.
1. Put more money in the Medicare budget. Residency funding comes from the Medicare budget and there hasn't been an increase since 1997. Congress needs to move on this, but they need to specifically open up funding for internal and family medicine residencies.
2. Offer incentives like loan forgiveness for more doctors to go into primary care.
3. Utilize non doctors for more of the administrative work so they aren't overburdened with that aspect of the profession and can concentrate more time and energy on actually working with patients.
4. Utilize PAs and NPs more and allow them to have greater responsibilities.
Reasonable suggestions.
I'll defer to Hambone with respect to #1, because he is more knowledgeable than probably any of the rest of us regarding the ins and outs there.
My preferred approach, French Bismarck, deals with #2 and #3 with structural provisions that I would favor. Interestingly, one (of many) problems with Obamacare is that it makes the situation very much worse regarding your #3.
#4 is a very good idea that is pretty much being driven by market forces, independently of the health care system in place.
(05-24-2015 08:38 PM)Owl 69/70/75 Wrote: [ -> ]Reasonable suggestions.
I'll defer to Hambone with respect to #1, because he is more knowledgeable than probably any of the rest of us regarding the ins and outs there.
My preferred approach, French Bismarck, deals with #2 and #3 with structural provisions that I would favor. Interestingly, one (of many) problems with Obamacare is that it makes the situation very much worse regarding your #3.
#4 is a very good idea that is pretty much being driven by market forces, independently of the health care system in place.
Ham has been calling for increasing the number of residency slots. The ACA actually originally included increased residencies but it didn't make it into the final bill.
With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
(05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
I thought this thread was going to be about PCP the drug.
(05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ] (05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
that's what my BIL is telling his daughter (he's an ENT)
The answer is going to involve H1B visas and mega practices that are large enough to cut large deals on malpractice- or self insure- and have an army of lawyers on staff. Medicine is going to be corporatized and the local private practice doctor is going to get pushed out just like every other industry has done in the last 20 years. You'll be getting your primary care at Walmart by some guy fresh off the boat from Bangladesh making $55k per year and you'll be signing a stack of liability waivers and agreements to protect Walmart. That is the future of American medicine.
(05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ] (05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
Well there seem to be a lot more people trying to get in med school than there are med school slots. I don't think the pool of candidates is going to dry up. When Campbell's Med school opened a few years ago they where able to be extremely selective in admissions and that was with private school tuition costs. It hasn't let ups since.
Ham might be able to elaborate more but establishing residencies doesn't seem like "meddling" to me. Without that government involvement how else would we get highly qualified, well trained doctors? I don't think hospitals are going to be inclined to take in those med school graduates without the federal government funding them?
Is providing government loan forgiveness meddling? What about specifying types of residencies that open up more slots for internal medicine and less for fields that have more then enough doctors in that specialty already?
(05-25-2015 08:32 AM)EverRespect Wrote: [ -> ]The answer is going to involve H1B visas and mega practices that are large enough to cut large deals on malpractice- or self insure- and have an army of lawyers on staff. Medicine is going to be corporatized and the local private practice doctor is going to get pushed out just like every other industry has done in the last 20 years. You'll be getting your primary care at Walmart by some guy fresh off the boat from Bangladesh making $55k per year and you'll be signing a stack of liability waivers and agreements to protect Walmart. That is the future of American medicine.
While that might be carrying it to a bit of an extreme, in general you are probably right. Like the house call doctor of a hundred years ago, the one or two doctor small private practice is going to be nothing but a memory. Hospitals have been buying up private practices for a while now and turning into medical care networks. I don't think it is all a negative though. I use to have to drive an hour to a cardiologist (still do for my wife) but I just did a stress test three blocks from my home because UNC has set up offices in the small towns all over he area.
Meh there are decent ones, but I object to the fact that these conglomerates give PCPs bonuses for in network referrals and bonuses for writing scripts for medicines. I will always trust the guy with his own practice more because s/he is practicing medicine and giving real opinions instead of just following a flow chart.
(05-25-2015 08:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ] (05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
Well there seem to be a lot more people trying to get in med school than there are med school slots. I don't think the pool of candidates is going to dry up. When Campbell's Med school opened a few years ago they where able to be extremely selective in admissions and that was with private school tuition costs. It hasn't let ups since.
Ham might be able to elaborate more but establishing residencies doesn't seem like "meddling" to me. Without that government involvement how else would we get highly qualified, well trained doctors? I don't think hospitals are going to be inclined to take in those med school graduates without the federal government funding them?
Is providing government loan forgiveness meddling? What about specifying types of residencies that open up more slots for internal medicine and less for fields that have more then enough doctors in that specialty already?
PCP doesn't pay like it used to. The competition is in surgery. There is still high demand for med school, but nobody wants to go into family practice. It has become paperwork, prescribing antibiotics, and referrals for a salary you can get other places without the extra schooling. Surgery still pays.
(05-25-2015 09:19 AM)EverRespect Wrote: [ -> ] (05-25-2015 08:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ] (05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
Well there seem to be a lot more people trying to get in med school than there are med school slots. I don't think the pool of candidates is going to dry up. When Campbell's Med school opened a few years ago they where able to be extremely selective in admissions and that was with private school tuition costs. It hasn't let ups since.
Ham might be able to elaborate more but establishing residencies doesn't seem like "meddling" to me. Without that government involvement how else would we get highly qualified, well trained doctors? I don't think hospitals are going to be inclined to take in those med school graduates without the federal government funding them?
Is providing government loan forgiveness meddling? What about specifying types of residencies that open up more slots for internal medicine and less for fields that have more then enough doctors in that specialty already?
PCP doesn't pay like it used to. The competition is in surgery. There is still high demand for med school, but nobody wants to go into family practice. It has become paperwork, prescribing antibiotics, and referrals for a salary you can get other places without the extra schooling. Surgery still pays.
Yes, we need to make PCP more desirable coming out of med school. Administrative paper work needs to be delegated to medical administrators as much as possible. More family and internal residencies need to be available and fewer for those specialties there are an over abundance of.
The two medical schools I am most familiar with (Campbell & ECU) do try to steer students into these areas, especially in the rural areas where shortages are most severe. Almost all of Campbell's residencies are with rural hospitals and studies find that it is more likely that a doctor will practice in a rural area if they do their residency in a rural area.
(05-25-2015 10:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 09:19 AM)EverRespect Wrote: [ -> ] (05-25-2015 08:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ] (05-24-2015 09:00 PM)Claw Wrote: [ -> ]With all the crying for infrastructure improvement, we have done nothing to produce more doctors.
Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
Well there seem to be a lot more people trying to get in med school than there are med school slots. I don't think the pool of candidates is going to dry up. When Campbell's Med school opened a few years ago they where able to be extremely selective in admissions and that was with private school tuition costs. It hasn't let ups since.
Ham might be able to elaborate more but establishing residencies doesn't seem like "meddling" to me. Without that government involvement how else would we get highly qualified, well trained doctors? I don't think hospitals are going to be inclined to take in those med school graduates without the federal government funding them?
Is providing government loan forgiveness meddling? What about specifying types of residencies that open up more slots for internal medicine and less for fields that have more then enough doctors in that specialty already?
PCP doesn't pay like it used to. The competition is in surgery. There is still high demand for med school, but nobody wants to go into family practice. It has become paperwork, prescribing antibiotics, and referrals for a salary you can get other places without the extra schooling. Surgery still pays.
Yes, we need to make PCP more desirable coming out of med school. Administrative paper work needs to be delegated to medical administrators as much as possible. More family and internal residencies need to be available and fewer for those specialties there are an over abundance of.
The two medical schools I am most familiar with (Campbell & ECU) do try to steer students into these areas, especially in the rural areas where shortages are most severe. Almost all of Campbell's residencies are with rural hospitals and studies find that it is more likely that a doctor will practice in a rural area if they do their residency in a rural area.
You do know you just because you add more medicine residency slots doesn't mean you will add more primary care docs....
(05-25-2015 09:11 AM)EverRespect Wrote: [ -> ]Meh there are decent ones, but I object to the fact that these conglomerates give PCPs bonuses for in network referrals and bonuses for writing scripts for medicines. I will always trust the guy with his own practice more because s/he is practicing medicine and giving real opinions instead of just following a flow chart.
This really isn't how it works
(05-25-2015 11:15 AM)maximus Wrote: [ -> ] (05-25-2015 10:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 09:19 AM)EverRespect Wrote: [ -> ] (05-25-2015 08:51 AM)dawgitall Wrote: [ -> ] (05-25-2015 07:59 AM)Fo Shizzle Wrote: [ -> ]Why would anyone consider this field now? There are much more lucrative fields for these top tier students that do not require the upfront costs and later sacrifices of being an MD. The governmental meddling has created this problem. Now more governmental meddling will be needed to address it? It is another example of the never ending consequences of government intervention into the marketplace.
Well there seem to be a lot more people trying to get in med school than there are med school slots. I don't think the pool of candidates is going to dry up. When Campbell's Med school opened a few years ago they where able to be extremely selective in admissions and that was with private school tuition costs. It hasn't let ups since.
Ham might be able to elaborate more but establishing residencies doesn't seem like "meddling" to me. Without that government involvement how else would we get highly qualified, well trained doctors? I don't think hospitals are going to be inclined to take in those med school graduates without the federal government funding them?
Is providing government loan forgiveness meddling? What about specifying types of residencies that open up more slots for internal medicine and less for fields that have more then enough doctors in that specialty already?
PCP doesn't pay like it used to. The competition is in surgery. There is still high demand for med school, but nobody wants to go into family practice. It has become paperwork, prescribing antibiotics, and referrals for a salary you can get other places without the extra schooling. Surgery still pays.
Yes, we need to make PCP more desirable coming out of med school. Administrative paper work needs to be delegated to medical administrators as much as possible. More family and internal residencies need to be available and fewer for those specialties there are an over abundance of.
The two medical schools I am most familiar with (Campbell & ECU) do try to steer students into these areas, especially in the rural areas where shortages are most severe. Almost all of Campbell's residencies are with rural hospitals and studies find that it is more likely that a doctor will practice in a rural area if they do their residency in a rural area.
You do know you just because you add more medicine residency slots doesn't mean you will add more primary care docs....
Yes, that is why I was said the part about more residencies for internal and family and less for specialties where there is an overabundance.
There are two problems:
1) government is too involved in healthcare, keeping reimbursement levels low.
2) the cost of malpractice insurance.
Get government out of healthcare and pass tort reform. Then we'd have enough doctors to meet the need. Other solutions are just band aids and rearranging the deck chairs on the Titanic.
If insurance companies were able to sell policies in any state, without the state insurance bureaucracy getting involved, competition would open up.
Right now, every state sets its own requirements for what a policy must include.
For example, in New York, a standard health care policy includes almost all of the services that Obamacare requires. If a New York resident could buy a more basic policy, there would be more choices. More choices begets better options begets more choices.
(05-24-2015 05:45 PM)dawgitall Wrote: [ -> ]http://www.wsj.com/articles/SB1000142412...1780608174
This has been the subject of much discussion in other threads so I thought I would create a thread for it. The above WSJ article offers some good possible solutions. Like most problems there appears to be no one solution, but instead several approaches that need to be taken. Here are four that make sense to me.
1. Put more money in the Medicare budget. Residency funding comes from the Medicare budget and there hasn't been an increase since 1997. Congress needs to move on this, but they need to specifically open up funding for internal and family medicine residencies.
2. Offer incentives like loan forgiveness for more doctors to go into primary care.
3. Utilize non doctors for more of the administrative work so they aren't overburdened with that aspect of the profession and can concentrate more time and energy on actually working with patients.
4. Utilize PAs and NPs more and allow them to have greater responsibilities.
Number 1 is good. I'd also like to mandate that a certain percentage of medical school slots and residency slots at hospitals subsidized by taxpayers be held only for those doing Primary Care. And make doctors who take one of the PC slots serve the public as a primary care physician accepting government insurance for a certain number of years (say 15-20) prior to moving out of it. If they don't serve, then they'll need to pay a recapture fee for the subsidy they received in their education.