Shortage of Doctors Proves Obstacle to Obama Goals

[Frank Booth]

Source: NY Times

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

Read more: http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=1&partner=rss&emc=rss&src=igw

---

Why does everyone have to be so flippin' greedy? I thought these guys got into the profession because they wanted to help people . . .

[Mind_your_head]

1. Tis true.....they got into the profession to help people.....

However, today's "system" does not promote/allow Doctor's to "help people" without the Dr.'s having to jump through "considerable hoops" ~ their patients as well.

Single Payer Healthcare USA! THAT's the best answer!

Peace,
M_Y_H

[Delphinus]

10. Amen!

HR 676 - get your congressional rep to sign on to this bill.

[NashVegas]

26. Yeah, Every Brain Surgeon I've Ever Met Talks About Their Love of Humanity

And how it drove them to become a doctor.

[Mind_your_head]

72. You've needed a lot of brain surgery, have you?

Hence, that's how/why you *have met a lot of brain surgeons", I suppose?

I knew there was *something* about you.....

[pnwmom]

2. I think it is high time we valued the work of family doctors and internists.

The gap between them and specialists is out of proportion and should be corrected.

[Mithreal]

4. I'll second that. nt

[Mithreal]

3. We must invest in free college and higher training for everyone.

Then we can expect doctors and others to focus more on contributing to society without having to worry about a massive debt at the beginning of a career or how much they are being reimbursed by the government.

[greymattermom]

5. India

Most of the new residents in medicine are from India. They don't have a big debt to deal with after getting their MDs, but I wonder how India can afford to train so many physicians for the US.

[saigon68]

9. They don't treat the slumdogs

Those people live in squalor---die in squalor.

The bright ones come here and become insert your word_____________

[Delphinus]

11. Oh, my.

There are so many things running around in my head right now ...

[jb5150]

6. That's sad

There are not enough doctors to practice their love with women...

[JDPriestly]

7. Getting a medical degree costs a small fortune and takes

many years. That is why you have to pay a doctor so much money -- so the doctor can repay student loans and make up for the years in which the doctor had no income.

Doctors do not earn nearly as much as CEOs of companies or even the more highly paid lawyers and upper level corporate managers who are not CEOs.

[WriteDown]

24. And yet many doctors work 4 days a week and drive home

in Porshes. Its a very odd paradox indeed. :eyes:.

There is an easy solution. Provide free education to those who have the grades and make them govt employees on government pay scale.

[Frances]

29. Not my primary care physician!

He's great, but he works for a salary. He's also in his 50s. And since I'm on Medicare, the company he works for doesn't paid much when I visit. The company has to pay rent for their building, salaries to the receptionists, and insurance for malpractice and the building, as well as other costs.

My daughter got an M.D. in 1995. She's still paying off her medical school loans. I think she's paid off her college loans.

I don't think bright, hard-working young people are going into medicine the way they used to. The pay they receive doesn't justify the work, long hours, and debt.

If you have watched ER, you can see that those doctors aren't making that much money.

[LanternWaste]

52. I don't think...

I don't think many people put too much thought into their denigration of doctors-- doctors are merely the most obvious (and hence, easiest) target. When pressed for details and statistics, don't expect anything more than anecdotal stories (more fiction than not I would think) and a few links to Hollywood or Manhattan Plastic Surgeons-- nary a peep or a squeak about the rank and file doctor under 45.

The average medical school debt has climbed 6 percent or more annually in recent years. The mean debt for 1999 graduates, including college debt, was nearly $91,000, compared with about $60,000 in 1993. At the same time, residents' stipends have been growing only 2 percent annually. This year's average is about $35,000, according to the Association of American Medical Colleges. (ripped from AAMC, 2001 issue-- can only be worse in the here and now).

But people still want to cling to myth of the rich, decadent, lazy doctor who plays golf four times a week, owns seven high dollar cars and a vacation home in Cancun-- and as the myth validates the myopic, preconceived conclusions drawn by many who would rather huff than learn, don;t look to see that particular attitude change any time soon.

(I worked five years at a non-profit cancer practice in TX and got to know the doctors pretty well-- and when they ask you for a ten spot to tide their gas tanks over til the end of the month, your perspectives change pretty rapidly... :P )

[Thor_MN]

66. When I was pre-med in 1984, when I was a junior in college

the figure that I heard quoted as the average debt projected for class of 1984, on exiting med school would be $100K. I had already taken and done very well on my MCAT, but that $100K figure was so massive, considering that I had zip in resources, that I decided that becoming a doctor was beyond my means. I think somewhat differently about $100K dollars now, but at that point, it was an insurmountable amount of money.

[Frances]

68. Thanks for your post

When I lived in Maryland, my neighbors, a brilliant husband and wife with Harvard medical degrees, gave up their medical practice for jobs because their pediatric practice wasn't making enough money to live on decently.

Another friend's husband gave up his medical practice for an executive position in a HMO because that was, as my friend said, where the money was.

I still feel angry that HMO executives are skimming the money of patients off the top. Something is wrong with this system.

[Dreamer Tatum]

33. That's a solution?

Most people with brains wouldn't trade the current regime for one that allows for free education
so long as the government caps their income forever.

[WriteDown]

34. Tough for them then...

Let people who really love medicine and helping people go into the field then. Cap the salary at 75K for most areas and higher for large urban areas.

[Dreamer Tatum]

36. And you think there aren't enough doctors NOW?

Oh man.

[Iowa]

41. Yep...

Remove the barriers and you'll be beating them back. And in addition to the ridiculous costs, remove other barriers as well - like the requirement that you sacrifice any semblance of a normal life, or that you must work obscene hours during training and in practice. Make it a decent 40 hour/week job that pays a middle-class wage and people will be lining up to do it.

[christx30]

64. You're right

people will be lining up for it.
And by people, I mean patients. There aren't enough doctors. You take the schedules that doctors have now and just put them down to 40 hour weeks and there still won't be enough doctors to see everyone. I mean... It takes 23 years to train a doctor from grade school to getting the license. And with the deficit the way it is, we simply can't afford to do everything we want to do, no matter how high we raise the taxes. Plus, if we tax these people back to the stone age, who is going to want to do the work?

[Iowa]

69. Nah...

There are many, many smart young people who would get into medicine were it not for the cost and lifestyle barriers. Our universities are already churning out tens of thousands of brilliant graduates with worthless degrees who end up under-employed in dead-end jobs. Provide these folks with a clear path to a decent job, where they can really make a difference without sacrificing a decent lifestyle, and they'll be lining up for it.

And taxes??? Forget about it! The country is already pouring an ocean of money into a health-care system that is a mess. Redirect some of that wasted money into education. Double the number of primary care physicians with the massive amount of money that is being skimmed off by worthless, useless, insurance companies.

[tblue37]

61. By going into the highly paid specialties, rather than into general practice or family care.

My daughter's dream was to work in underserved communities--including joining Doctors without Borders. She still wants to do that, but admits that she will have to spend at least 10-20 years working in the US and earning a lot of money to pay down that debt first.

[mbperrin]

42. And yet my bachelor's degree in economics and English, and

my 6 teacher certifications, a semester of free student teaching, and my master's degree took 7 years, cost $160,000, and I teach for less than $50k a year after 13 years experience. Doctors take 8 years.

The real reason doctors get paid so well is that it has been the official policy of the US government to limit the number of doctors since 1972. In the early 70s, doctors and lawyers made very equivalent salaries. The doctors got protection for limiting themselves, and lawyers didn't - now about a 7X salary difference.

We also limited hospital construction, limited the number of programs existing med schools could offer, limited incoming student body sizes.

Supply restriction works - income for doctors rose quickly.

[Frank Booth]

55. Yep. I finished school with a similar debt load, and will be paying it off for years to come.

It's not just doctors who have to deal with the ridiculous costs of higher education.

[tblue37]

60. My daughter graduated from medical school last May--a

quarter million dollars in debt! During her residency in Orlando, FLA, she will not be making much money at all, for several years. She drives a car that shakes like it wants to fall apart at any minute, because she has no money for a new one--or even a good used one. It will be years before she can think about being able to afford a family, a home, or much of anything. Meanwhile, during med school and during her residency (and her career, too, once the residency is over), she will be working impossible, exhausting hours. She will also have to pay a fortune each year for malpractice insurance, as well as paying down her med school debt.

Other countries subsidize their young people's post-secondary education, especially if they are in a necessary field. All our American kids go deeply into debt even for their basic undergrad degree, much less their professional training. A friend of mine who just started law school last year will be $100,000 in debt when he is done. No wonder these young folks have to scramble for the high-paying jobs. They can't begin to pay down their debt if they don't.

Among undergraduates, of course, being a brilliant student won't win a person a full-ride scholarship, but being a talented athlete will--even if one is barely literate. Our values are so freakin' skewed in this country!

[bmbmd]

78. I've been practicing thirty years.

I knew going in that it would take me a lifetime to payoff educational and startup loans, and I don't regret that. What I regret is that I absolutely missed my twenties and thirties-eighty hours plus a week during residency, sixty hours plus a week for ten years starting up. I spent my youth learning my craft. That's the part I want back.

[Lasher]

8. Shortage of General Practitioners

Then change the process so that general practitioners are not needed as much. This needs to be done anyway. I can't fart unless I first get an approval/referral from my PCP.

[Trajan]

54. I would not have a PCP that was not in General Practice

Family Practice or an Internal Medicine physician ...

Isn't that the general rule ?

[Lasher]

65. Yes, you need a PCP who is a general practitioner

But you should be able to see a gynecologist for an annual routine exam, for example, without getting a referral from your PCP. Another thing is prescriptions. Let's say you have to take blood pressure medicine for the rest of your life. So why can't you get a prescription with unlimited refills? But no, the PCP writes you a prescription with 3 refills. After that you have to call your PCP and have them call a new prescription in to the pharmacy. If your doctor will even do that. Some make you go into the office to get the piece of paper, then take it to the pharmacy.

I'm protesting needless interaction, not the role of general practitioners as PCPs.

[melm00se]

12. this has been one of the

biggest issues with universal health care: getting enough people to treat these folks. This is something I have been saying for years.

it takes no less than 11 years to educate a family practice physician: 4 years of college, 4 years of medical school + 3 years(at a minimum) of residency (http://residency.wustl.edu/medadmin/resweb.nsf/0ee53e934810efcd86256a94005e5f7d/3edd4e91945f8a2b86256f850071ae49?OpenDocument)

it will take, in reality, 4-8 years to ramp up enough physicians to meet the needs of American health care if an additional 40+ million patients into the system. This does not include the need for: nurses, technicians, facilities, beds etc.

[Demeter]

13. My Dad in DC Had a Horrible Time Finding Any Dr. to Take New Medicare Patients

DC has this "concierge" system: you pay $1600 to put a doctor on retainer, and then you have access, whether you need it or not. But try and find someone who will take the pittance that Medicare, the victim of repeated "cost-cutting" in the Congressional budget process, will reimburse...

Doctors are pulling in millions under the "concierge system" before they even see Patient #1.

[MannyGoldstein]

16. Medicare Reimburses Just Fine

If docs were only paid at Medicare rates, then they'd still make twice what docs make in Europe.

But docs want more, if they can get it. They're entrepreneurs.

[Sgent]

38. Where do you get your facts?

GP's in the UK make about 1/3 more than FP's in the US -- and generally work fewer hours and have free education.

[MannyGoldstein]

47. That Might Be True For GPs/FPs in US vs UK

But, overall, US docs make way more. I don't think many docs in the the UK get $500k+, but that's not uncommon in the US for some specialties.

For example, look here: http://www.worldsalaries.org/generalphysician.shtml

[Sgent]

48. I just looked it up...

and I was wrong.

GP/FP compensation is about the same in the UK/US, depending on where you practice and if you do OB/GYN or not (in the US).

That being said, they still generally have better work hours, benefits, and free medical school.

That's a change from when I looked at it about 5 years ago.

It looks like the higher paid specialties make about 250K.

For US salary look here: http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

[JDPriestly]

74. But, we are talking about GPs here, and they don't make all that much

in the U.S.

[Thothmes]

49. What are the Medical Malpractice Insurance Rates

in Europe?

[MannyGoldstein]

57. Compensation Is Typically Measured After Malpractice Is Paid

So it's not usually an issue.

Do you know what percentage of all medical spending is for malpractice insurance? Less than 1%. If payments are less than 1%, then payouts to plaintiffs and lawyers are far lower than that.

Some docs like to complain loudly about malpractice insurance and Medicare reimbursement, but neither is a big deal. Like most of us, docs very much want to make more money - even though they are already well compensated.

[Thothmes]

71. Thanks.

[JDPriestly]

73. GPs in Europe do not have to repay huge student loans.

That is the difference.

[Joanne98]

14. CUBA has a lot of doctors who would love to come here and work!

[Mika]

22. Was just going to post that, then I read your post.

:thumbsup: :thumbsup:


Amazing that Cuba was able to do this under the austere conditions they have faced...

Before the 1959 revolution

75% of rural dwellings were huts made from palm trees.

More than 50% had no toilets of any kind.

85% had no inside running water.

91% had no electricity.

There was only 1 doctor per 2,000 people in rural areas.

More than one-third of the rural population had intestinal parasites.

Only 4% of Cuban peasants ate meat regularly; only 1% ate fish, less than 2% eggs, 3% bread, 11% milk; none ate green vegetables.

The average annual income among peasants was $91 (1956), less than 1/3 of the national income per person.

45% of the rural population was illiterate; 44% had never attended a school.

25% of the labor force was chronically unemployed.

1 million people were illiterate ( in a population of about 5.5 million).

27% of urban children, not to speak of 61% of rural children, were not attending school.

Racial discrimination was widespread.

The public school system had deteriorated badly.

Corruption was endemic; anyone could be bought, from a Supreme Court judge to a cop.

Police brutality and torture were common.

___



After the 1959 revolution

“It is in some sense almost an anti-model,” according to Eric Swanson, the programme manager for the Bank’s Development Data Group, which compiled the WDI, a tome of almost 400 pages covering scores of economic, social, and environmental indicators.

Indeed, Cuba is living proof in many ways that the Bank’s dictum that economic growth is a pre-condition for improving the lives of the poor is over-stated, if not, downright wrong.

-

It has reduced its infant mortality rate from 11 per 1,000 births in 1990 to seven in 1999, which places it firmly in the ranks of the western industrialised nations. It now stands at six, according to Jo Ritzen, the Bank’s Vice President for Development Policy, who visited Cuba privately several months ago to see for himself.

By comparison, the infant mortality rate for Argentina stood at 18 in 1999;

Chile’s was down to ten; and Costa Rica, at 12. For the entire Latin American and Caribbean region as a whole, the average was 30 in 1999.

Similarly, the mortality rate for children under the age of five in Cuba has fallen from 13 to eight per thousand over the decade. That figure is 50% lower than the rate in Chile, the Latin American country closest to Cuba’s achievement. For the region as a whole, the average was 38 in 1999.

“Six for every 1,000 in infant mortality - the same level as Spain - is just unbelievable,” according to Ritzen, a former education minister in the Netherlands. “You observe it, and so you see that Cuba has done exceedingly well in the human development area.”

Indeed, in Ritzen’s own field, the figures tell much the same story. Net primary enrolment for both girls and boys reached 100% in 1997, up from 92% in 1990. That was as high as most developed nations - higher even than the US rate and well above 80-90% rates achieved by the most advanced Latin American countries.

“Even in education performance, Cuba’s is very much in tune with the developed world, and much higher than schools in, say, Argentina, Brazil, or Chile.”

It is no wonder, in some ways. Public spending on education in Cuba amounts to about 6.7% of gross national income, twice the proportion in other Latin American and Caribbean countries and even Singapore.

There were 12 primary school pupils for every Cuban teacher in 1997, a ratio that ranked with Sweden, rather than any other developing country. The Latin American and East Asian average was twice as high at 25 to one.

The average youth (age 15-24) illiteracy rate in Latin America and the Caribbean stands at 7%. In Cuba, the rate is zero. In Latin America, where the average is 7%, only Uruguay approaches that achievement, with one percent youth illiteracy.

“Cuba managed to reduce illiteracy from 40% to zero within ten years,” said Ritzen. “If Cuba shows that it is possible, it shifts the burden of proof to those who say it’s not possible.”

Similarly, Cuba devoted 9.1% of its gross domestic product (GDP) during the 1990s to health care, roughly equivalent to Canada’s rate. Its ratio of 5.3 doctors per 1,000 people was the highest in the world.

The question that these statistics pose, of course, is whether the Cuban experience can be replicated. The answer given here is probably not.

“What does it, is the incredible dedication,” according to Wayne Smith, who was head of the US Interests Section in Havana in the late 1970s and early 1980s and has travelled to the island many times since.

[Thothmes]

50. With number like this

it is a wonder that many Latin America citizens are not trying to get into Cuba? rather than here

[AlphaCentauri]

44. They would be immigrants taking the american jobs

just before somebody else post that question.

[MannyGoldstein]

15. US: Only Half As Many Docs Per Capita Than Europe

The AMA does a great job of limiting the number of docs that enter the profession, artificially raising salaries. Europe has twice as many docs per capita, and they get paid 1/3 to 1/2 what docs make in the US. (And European health care costs 1/3 to 1/2 what ours does, and they have better medical outcomes).

[greymattermom]

17. increase class size, build new schools

Both are underway, but it most cases these are state schools and programs are on hold because states are broke. NIH has a loan repayment program for docs who go into research. A similar program is in place in my state if you go into rural medicine. More loan repayment programs for primary care would help. Another thing most people don't tell you is that at least half the class now is female and many either practice part time or don't practice after a few years.

[MannyGoldstein]

19. But It'd Piss Off The AMA

And I don't see Obama or Congress doing that.

[JDPriestly]

75. Those who make it into and through medical school in our country

have been vetted not only for intellectual ability, scientific knowledge and psychological health but also for character. Some people who are not suited for medicine sneak through, but the interview, testing and mentoring and evaluation processes are rigorous. That's why I prefer an American trained doctor, an American educated doctor to those who come from overseas. I know the selection process that our American-trained doctors go through. I can't think of any other profession that so carefully scrutinizes those who want to enter it. A lot of the stereotypes about soulless, uncaring doctors are just plain false.

If a doctor manages to get through college and then medical school and the whole interview and practical process that means, once they get into residency, their dedication, the sincerity of their commitment to healing patients is closely observed and evaluated by the attending doctor with whom they work. Residents develop pretty close relationships with the doctors that mentor them during residency. Carelessness, callousness, bad habits -- get noticed at this point and can mean problems for the resident -- even after all those years of hard work. Our doctors survive an educational and training obstacle course. Those who make it into the profession are the very top not only in terms of medical knowledge but also in terms of compassion, work ethic and human qualities.

[Aragorn]

18. this is getting silly

1) Single payer as it is now (Medicare, and Medicaid) pays all specialists and PCPs the same. There is no difference between them, or for the same procedure no matter who does it. (There MIGHT be 1 or 2 exceptions out of thousands of procedure codes but none I know of.) Historically lucrative procedures such as certain surgeries have been reimbursed less already. But, for example, when cataract surgery became laser-ized, and the cost fell but the reimbursement did not, you had surgery centers picking up cattle - oops I mean patients - in limousines. The guilds such as medical boards and medical societies are the ones who funnel certain procedures to certain groups (specialists), not the specific doctors who provide care. And certainly not the patients. But those guilds can sure slap down a doctor who rocks the boat, and can do so with impunity.

2) Doctor shortages, when they exist, are usually due to rural versus urban issues, particularly with specialists. Medicare offers a small and frankly inconsequential bonus to address this.

3) Greed IS an issue with some doctors, although more so with hospitals and drug companies. But this problem would be eliminated if everyone had health insurance. Why? Because even those doctors who chase the smaller number of presently insured patients for more and more money - oops, I meant procedures and tests - would then have a whole lot more legitimate and insured people to treat.

4) Privatization of Medicaid services as some states have tried has never helped. Ask Howard Dean, for instance.

5) Privatization of specific areas of medicine (like mental health clinics) has never worked. It is politically expedient to "cap costs" but in effect that tells some for-profit company "Here's your entire yearly gross income. Whatever you have left is your profit." And guess what? Denying services means more money left over.

When I see a non-insured, barely employed person who has been turned away from the ERs and cannnot afford to go to any one else, because of an infected tooth, and do it for free, do you think my colleagues applaud, or moan the upsetting of the present power structure? I did this last Sunday afternoon, and have done this type of thing often.

Even the volunteer clinic I work at for free 1 morning a week charges patients, and they have almost a million dollar a year budget. And do not see any unemployed, Medicaid, under-insured, etc.

[Iowa]

43. Well I applaud you!

"When I see a non-insured, barely employed person who has been turned away from the ERs and cannnot afford to go to any one else, because of an infected tooth, and do it for free, do you think my colleagues applaud...?"

I'm not a colleague, but I applaud you for doing that. And I'm sure anyone who reads your post applauds you as well.

:applause: :applause: :applause: :applause:

[chill_wind]

59. I too applaud you for this-- and cannot say enough about its goodness--

When I see a non-insured, barely employed person who has been turned away from the ERs and cannnot afford to go to any one else, because of an infected tooth, and do it for free, do you think my colleagues applaud, or moan the upsetting of the present power structure? I did this last Sunday afternoon, and have done this type of thing often.

[pattmarty]

20. I have given this some thought in the past about single payer...............

.......if it ever were to pass here. We definitely would be short nursing staff and I would think both primary care and specialists it everyone were to be covered "all at once". What probably would happen is a staged implementation to avoid a "rush" on the system. Possible to insure all kids say under 16 at first, then gradually in stages include other groups until maybe in 10 yr or when the nursing staffing and doctor pool increases. All of the "obstacles" can be overcome with patience and determination. All of us here know it'll be well worth it.

[Psychic Consortium]

21. Maybe it is time to decrease the cost of med school.

Some docs use this as an excuse to become millionaires while children go with out health care and medicine.

[WriteDown]

25. That would be a good first step...

Putting doctors on a govt pay grade system would be the next.

[Psychic Consortium]

77. 21st century: people should not get rich from other's suffering and pain. nt

[jody]

23. Not to worry, there are millions of MDs from other countries who will come to the US. Sad that their

home countries will then face a greater shortage of MDs.

[Dreamer Tatum]

27. The AMA regulates the number of doctors practicing in the US.

It's a labor union. It will have to be destroyed to have nationalized healthcare.

[saigon68]

30. And their million dollar salaries will shrink

[jody]

32. Not all MDs have "million dollar salaries". More than 50% of MDs work in salaried positions, a stat

that is a decade old and probably more than 60% or more today.

[jody]

31. Understand and ADA "regulates the number of doctors practicing dentistry in the US." It's probable

a national medical insurance program will include extensive dental care, I've read one bill that does, and if funded, it will IMO place a greater strain on existing Doctors of Dentistry than on existing Doctors of Medicine.

[Sgent]

40. No it doesn't

the AMA has nothing to do with the number of spots available at Medical Schools -- and very little to do with the number at residencies (which there are plenty of unfilled spots open for primary care physicians).

The main reason that there has been no recent expansion is Medicare caps. Medicare reimburses teaching institutions 100K or so per year for residents -- but has refused to open more spots in years.

[Thothmes]

51. Dont We support Labor Unions?

[kwassa]

28. The cost of malpractice insurance kills the income of many general practitioners.

A big problem here in Maryland. My doctor sold his practice and bought into one in Idaho because he said he couldn't afford to send his kids to college. The surgeon who operated on me said that they can't find surgical residents for a presigious local hospital because of the high malpractice costs.

[JDPriestly]

76. Here in California we have caps on medical malpractice verdicts.

The insurance companies, nevertheless, demand kings' ransoms for coverage. They invest the premiums they receive and when the stock market is down so are the profits of the insurance companies. They just charge what the market will bear I believe.

I have to add that in order to prove medical malpractice, a plaintiff in California has to bring evidence that the parties accused of the malpractice did not meet the standard of care. It's hard to find medical experts to support medical malpractice claims. Medical malpractice suits are not successful nearly as often as you might think. Of course, just defending a lawsuit costs a lot of money.

Face it. Mistakes do happen and sometimes doctors or hospitals or nurses do not meet the standard of care. It doesn't mean they are "bad" doctors. People have bad days. No one is perfect. And medicine is part science but also part art and part luck, so accidents happen in medicine just like they do in truck-driving or woodworking.

If we had single-payer, we would have many fewer medical malpractice lawsuits. The dilemma for a patient is that if the patient has been harmed in a way that could mean unknown future medical costs, the patient must either sue the doctor to recover those potential costs or bear the burden of paying them him- or herself. So, if we had single payer, a major incentive for medical malpractice lawsuits would be removed.

[Matariki]

35. Yeah well. Maybe address the fact that people leave medical school with a half million in debt

No forethought whatsoever when Reagan nuked financial aid.

[Bigmack]

37. Socialism....we need it!

Med school for free for the qualified... in return for number of years working in public clinics or hospitals. Federal malpractice insurance... with mediation and arbitration.

School loans given and administered by the government.

We don't NEED the insurance and banking bloated bureaucracies.

[damntexdem]

39. Physicians Assistants and nurse practitioners can substitute for primary care physicians.

And do it more cheaply.

Of course, that would mean needing to increase the supply of PAs and NPs.

[Iowa]

46. I have Cadillac health insurance and can choose any provider I want...

I have a fee-for-service plan and can go to any physician in the country, yet I choose to go to a PA. These people can be VERY good, especially for primary care types of issues. In my experience they tend to take the time to REALLY think it through before acting. I have never been too impressed with NPs, however.

[Sgent]

53. They are fine

for chronic stable conditions.

I've worked with enough of both to know I don't want to see one for a new onset disease, or a chronic disease with new complications.

They are also very good at some procedures -- wound treatment, etc.

[AlphaCentauri]

45. The problem is in the education system

if we are not producing enough doctors is because our education system is failing, we produce many economist just to screw our economy.

[mr11]

58. LOL, Agree.

:thumbsup: I'm not going to be no doctor of any kind or anything relating to the health care sytem, but just to think about all those expenses that will get you to be one? jeeez. Tuituion it what makes me think of dropping out, it just keeps getting higher. Something has to be done.

[AlphaCentauri]

62. You know, many losers end up with a business degree

they can't even touch science

[mr11]

63. tuition*

[antigop]

56. Congress controls supply of physicians by ... federal funding it provides for medical residencies

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

The marketplace doesn't determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves.

Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.

To become a physician, students spend four years in medical school. Graduates then spend three to seven years training as residents, usually treating patients under supervision at a hospital. Residents work long hours for $35,000 to $50,000 a year. Even doctors trained in other countries must serve medical residencies in the USA to practice here.

Medicare, which provides health care to the nation's seniors, also is the primary federal agency that controls the supply of doctors. It reimburses hospitals for the cost of training medical residents.

The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.

In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.

Medicare, which faces enormous financial pressure in coming decades, already spends 3% of its budget training physicians and may not have the resources to spend more.

[greymattermom]

67. match day

I imagine that the percent of US med school grads who don't match is very low, only the last person in each class. The only trainees left are the foreign grads. To increase the number of US trained docs, there will need to be an increase in the number of US med schools, an increase in class size, and an increase in the number of residency slots. The only new schools are state schools and states pay a subsidy for med students in current schools. Medicare controls the number of residency slots. So, to increase the number of docs, both the state and federal governments will have to put up some cash. Where does this money come from? TAXES

[IndianaGreen]

70. Cuba will train medical students for free provided they serve the poor after graduation

This offer has been open for quite some time. What a better way to get around the artificial shortages in medical doctors caused by the AMA and their accomplices in American medical schools.

[GetTheRightVote]

79. I am still paying my student loans & I am no doc or nurse, no medical

period. I am a programmer for over a decade now. They are controlling all of our careers by hiring outsiders or out sourcing as much of the work as possible. The reason given, we have a brain drain in the USA. Now there is no doubt that there is greed in some career paths that needs to be handled and brought down so that people can afford the services provide due to them. One of these area is that of health care for sure. A national health care system is needed to cover everyone period. No one in this nation should go without this type of care so that health professionals can line their pockets. Now let's be honest about it, in the end they all do though it may take them a few years to reach that point. The real point is that for most of them, they do in fact get there and end up with a very nice car and a very nice home to live in.

A lot of health care personnel get into it because of the money or family connections, etc. because they have the money to get into. This is another problem in the health care systems within the USA, that we have a whole lot of really bad health care personnel who do not do a good or caring job because they do not have the talent or leanings toward it that someone who is born with the capability but does not have the money it takes to get the education. Even if we had a few less doctors in the end we would have better doctors, more caring doctors, more willing doctors when it came to the most personal care in this world for people, that of health care. The type of doctors, nurses, etc who did truly get into for the care of their fellow human beings. The greedy would take up some other profession instead because they are following the money tree.

:kick: