Friday, September 25, 2009

Let's find real solutions to the impending doctor shortage

One of the most common arguments I see in opposition of healthcare reform is that there are "not enough doctors" if everyone in the USA were to gain access to health care.

This argument irritates the hell out of me. What this really boils down to is, if those who currently do not have health insurance are, by way of reforms, finally able to access affordable (for them) health care, then those who are currently privileged enough to have health insurance may have to wait longer to get an appointment with a doctor.

In other words, "I got mine, screw everyone else, and don't you dare try to inconvenience me so that others can receive care."

Instead of trying to address the actual problem of potential doctor shortages, these people would rather deny healthcare to less privileged people. They will also say things like, "They should get a job and get health insurance like I do, by working for it*," all the while blinding themselves to the obvious fact that if that happened, there would still be the problem of not enough doctors; how those doctors are paid--by insurance companies or by single payer--is not going to matter a whole lot when there still aren't enough of them to care for all of our country's citizens. But of course, the teabaggers are counting on a significant portion of US citizens remaining in the position of not having health insurance. They aren't forward thinking enough to try to work on ways for the doctor shortage issue to be addressed, they just want to make sure they keep the status quo.

So what are some real solutions to this impending shortage of health care professionals (and, actually, despite our having the oh-so-fabulous system we have now, we actually have shortages right now, especially of general practitioners)? Now that we've established that denying health care to a large portion of citizens is NOT an acceptable solution, I have a number of suggestions for both increasing the number of physicians, and for reducing the demand on them:

1. Medical school enrollment hit an all time high in 2008. Obviously, there isn't a lack of interest in the medical profession. However, this makes me wonder how many well-qualified candidates didn't get accepted. Somehow, we need to increase the capacity of our medical schools so that many more good students are able to attend. I feel that anyone who feels a true calling to the profession, and who is intellectually capable, should have access to a spot in a medical school.

2. We also need to de-privilege medical school enrollment. Applicants who show great promise should be admitted regardless of their socioeconomic status, and we need to find ways to help less privileged applicants fund their education.

3. Regions that are experiencing the most severe shortages could offer grants to help a local student pay for medical school, with an agreement that they will return to the region to practice family medicine for a specified time period.

4. These same regions could ease family practitioners' overhead expenses by providing a city- or county-owned clinic facility. They would have an incentive to make these facilities comfortable and attractive so that the physician(s) will want to work there. I have seen some of the incredibly ornate and beautiful public libraries in some places, so why not create similar places for public clinics?

5. Offer similar incentives and opportunities to educate and recruit more nurse practitioners and physician's assistants; they can take a huge load off the doctors by serving patients. For those who are not in the US, people in these two jobs are able to see patients and perform most of the things a family practice physician does, but must practice under a supervising physician.

6. Adopt a single payer healthcare system! Our doctors currently spend an obscene amount of time and money trying to get insurance companies to pay their bills. Insurance companies currently spend an obscene amount of time and money trying to avoid paying doctors what they are due. Between arguing on the phone, filling out and faxing a ludicrous number of forms, and writing a bunch of letters explaining WHY Mrs. Jones really DOES need her lifesaving medication, doctors are cheated out of time spent with their patients and families. They either find themselves rushing through a double-booked schedule and not getting the chance to really connect with their patients, or they are cheated out of the income they would get by booking more patients in the time wasted wrangling with insurance. Many doctors report that Medicare and Medicaid don't give them the same headaches and runaround as insurance companies, and doctors in the UK and Canada often say that the single payer systems in those countries leave them with more time for patients and less overhead spent on staff needed to sort out insurance snafus.

7. Improve our education system so that gifted and talented kids of all socioeconomic backgrounds have a good shot at becoming doctors if that is their dream. Find more ways for our best and brightest to get into college and on the right track to med school. It's ridiculous that we have college recruiters for sports teams, but not for academics. Why isn't there a recruiter sitting in the back row of a biology classroom to pick out the best and brightest, to offer them incentives to pursue a pre-med career? Isn't creating more health care professionals more important than winning a few ball games?

There are surely countless other ideas out there to ward off the physician shortage that don't involve telling 47 million US citizens to suffer and die. What are your ideas?

* There is the fact that many people have jobs that don't give them health insurance--to which the teabaggers will often respond that it's the person's own fault for not pulling themselves up by their bootstraps and getting a better job. There are countless problems with that, however, with just a few of them being:
- Not everyone has the ability to become an engineer, or a lawyer, or some other profession that has decent benefits

- Teabaggers are anti-union, so they're actually against workers gaining access to better benefits

- They also vote for the corporate whores who send jobs overseas and sacrifice lower level jobs for CEO and upper management bonuses and (temporary and unsustainable) inflation of stock prices (which often end up eventually gutting the corporations for the sake of making a quick buck for investment bankers--and by the way, studies show the seven percent rule is a myth; GE and P&G pulled it off, but they're the exception, and companies trying to emulate their layoff tactics are not getting the results they wanted)

- There are not enough of these health-insurance-providing jobs for everyone; if there were, we'd all be working them

- Regardless of anything else, SOMEONE has to do the "less desirable" work that currently doesn't provide health insurance, and you know these selfish teabaggers are going to be the first to whine when there aren't enough checkout lanes open at Wal*Mart for their liking

- It's inhumane for a person to have to choose to stay with an abusive employer (or an abusive spouse whose employer provides health insurance) because they've got a health condition that would be impossible to manage without insurance (and impossible to get insurance coverage for outside of employer-offered).


Rebecca said...

Our aunt went to a tea party...

occhiblu said...

Your Point #6 really ties in with the lack of general practitioners in general -- GPs and family doctors have been leaving the profession in droves since managed care came along, because they can basically no longer practice medicine (a) effectively or (b) without going broke. In the 1980s when they were gaining popularity, HMOs hyped GPs as the new front-line practitioners and donated money to med schools for bigger GP/Family Practice programs; then the insurance companies started cutting down reimbursements and basically ensuring that GPs couldn't spend more than 10-15 minutes with a patient. An article in JAMA a few months ago talked about how this creates complete burnout, because you have doctors who *want* to help people completely unable to do so given time constraints, and unable to spend more time due to financial constraints (i.e., not being able to pay for their overhead if they don't see a certain number of patients each day).

Specialists can kind of make up for some of those financial constraints with fancy testing, which gets reimbursed at a higher rate.

So, given that, my suggestion would be to not only switch to single payer, but to make sure reimbursements for standard appointments are higher, especially for GPs and family practitioners. We have a perverse financial incentive right now that encourages fancy tests and discourages patients and physicians *talking* to each other about the patient's problem. Switching that would encourage more physicians to stay in the profession, because it would lead to greater job satisfaction and better patient outcomes.