Impending doctor shortage?

October 31, 2007 at 10:46 am (Uncategorized)
Tags: Doctors, Health, Health care, Unnecessary Regulation

Courtesy of Reuters comes an article that discusses the coming retirement and career changes of physicians between the ages of 50 and 65. That group represents about 1/3 of all doctors in this country, and according to a survey conducted a fourth are planning on leaving the profession in the next few years:

Specifically, 14 percent said they were planning on retiring, 7 percent said they were looking for a medical job in a non-patient care setting, and 3 percent said they were seeking a job in a non-medical field.

It’s not really news to see that 14% of older physicians are planning to retire – a lot of people in that age range are nearing their retirement. The survey finding I did find interesting was this:

When asked about the work ethic of physicians entering practice today, 68 percent of the respondents said that these younger doctors are not as dedicated or as hard working as physicians who entered practice 20 to 30 years ago.

Ha! Granted I’m only a medical student and not a physician, but it’s quite funny to me that they don’t think I’m as hard-working as they are. Many people don’t know what it’s like to be in medical school, but it pretty much takes up you’re entire life. We study all the time, and when I say all the time I don’t mean a 40-50 hour week. I mean you wake up, go to class, maybe take a break for lunch, study, take a break for dinner, and study more. Weekends are usually filled with some degree of more studying. We don’t study this much because we want to, but because that’s what it takes to pass exams, and more importantly, prepare to pass the licensing exams (USMLE). I’m not as bad as some of my classmates, but I definitely have a few friends who literally study from 8 am to 10 or 11 pm, and then spend almost their entire weekend in the library. Medical students don’t really go out and party (at least at my school), unless it’s the day after an exam when we get a brief break. It’s just funny to me that older docs don’t think we work as hard, especially given that a lot of the material we have to learn now was not taught when they were in medical school because the medications didn’t exist or the disease mechanism wasn’t well understood. Our professors have to update their lectures every year to reflect all of the advances made in medicine. I will say that I doubt this generational view is specific to physicians – I’d bet that if you surveyed any older professionals about their younger peers, they would say the youngsters don’t work as hard. Another finding of the survey, which was a bit sad to me, is this:

Fifty-seven percent of older physicians said they would not recommend medicine as a career to their own children. Similarly, 44 percent said they would not select medicine as career if they were starting out today.

I understand that sentiment – it’s not that they don’t like treating patients, but is likely due to the fact that the medical field has significantly changed from when they started out. Paperwork is a nightmare, and you really don’t get to spend a lot of time with each patient. Patient’s definitely don’t like this, but neither do a lot of doctors! They want to spend more time with each patient, but if you saw all of the paperwork that must be filled out and all of the phone calls that must be made (regardless of whether it is private insurance or through a government system like the VA), you’d see that a huge chunk of their day is taken up in those less-than-desirable activities. Plus reimbursement is always an issue. Obviously they make a good living, but payment incentives tend to lie more with performing procedures rather than talking with the patient to understand all of the factors that are contributing to their illness.

The major concern, with older physicians leaving the profession, is whether the country will face a doctor shortage. The truth is, who knows? A lot of studies now point to both a doctor and nursing shortage in the near future. But, not too long ago a lot of studies predicted a surplus, to which the industry responded by restricting entry into the profession. The problem with the surplus studies is that they were made based on the assumption that our entire country would be under managed-care by now…a prediction that has since proved false. I think there is a good chance that there will be a doctor/nurse shortage – fortunately some actions are being taken to alleviate this, but unfortunately some are contributing further to the problem. First, the good – many medical and nursing schools are adding positions to their classes, and new schools are opening up. This is great, and in the next 5-10 years we should (hopefully) see a noticeable increase in health care providers. The bad news, is that lobbying groups and regulatory agencies continue to put restrictions in place to limit supply. Mostly this is done to ensure that these groups’ constituents continue to earn high wages (supply vs. demand), though they lobby under the pretense that they’re “ensuring quality” or something to that effect. Consider, for instance, that the medical licensing board has continually raised the minimum passing score. An intelligent person would say it’s great if 97-99% of medical students pass their licensing exam – it means that the schools are preparing them and covering all of the important material, and that the students are really working hard. But this group wants to maintain the pass rate at around 94% – so every time it starts to creep up, they raise the minimum pass score or make the exam harder (I don’t pay $40,000 a year and work my ass off to fail an exam). It’s great to increase the overall quality of the profession, but do those measures actually increase quality in the areas patients most desire? Doubtful – the best way to increase quality in areas that are important is to let the patient decide, not a licensing board or lobbying group. All they manage to accomplish is a further increase in their wages, which makes the medical care they provide expensive and unattainable for a significant portion of our population.

If we’re really serious about health-care – and given all of the attention it gets during election time I’m assuming we are – then we should deregulate some of this stuff. Lessen the licensing requirements and let the market pick quality physicians (they’d probably be less socially-inept bookworm and more warm-caring physician). Remove restrictions that physician-lobbying groups place on other health care providers – let nurses, physician-assistants, optometrists, physical therapists, etc occupy their rightful place in our health-care system. They’re capable of a lot more than we’re allowing, and it’s insulting and stupid to waste all of that talent and manpower (seriously…be skeptical every time you hear these lobbying groups tout “quality” as their motivation to place further restrictions on another group). Not only would this lower prices of care, it would open up the system to people who are currently shut-out. These regulations don’t ensure quality as much as they ensure that an increasingly larger share of people cannot afford the most basic care. That’s tragic, and completely unnecessary…it really doesn’t have to be this way, and there are better solutions to increase access that don’t involve a Hillary Clinton-styled single-payer system.

~ Lily