How in God's name are we going to pay for medical care for all of these new people (30 million of them!) when most of them do not work?
Where are we going to get the new doctors that are now required to care for them?
The Coming Doctor Shortage
If the argument for a wholesale revamping of American healthcare depends on the large number of uninsured, typically estimated at 45 million (although a New York Times editorial elevated the number of medically uninsured and underinsured to over 100 million), then there had better be some plan that goes along with the reform to find the 25,000 to 50,000 new physicians that will be required. And by the way, since the number of physicians retiring in the next decade will be about 25,000 per year, you can see we have a bit of a problem.
Will skilled surgeons be available after 2014 to save your life when you need them most?
Let’s say it all works out and we welcome the supposed 45 million or so individuals without healthcare insurance into the fold and they receive the preventive care and primary care that we are told will solve the problems of American healthcare .
Based on the assumption that these uninsured people are not receiving healthcare now, we will need about 100,000 more doctors than we have at present (our current physician workforce is about 900,000 physicians). This number is based on our current count of 2.43/1000 population according to the Organization for Economic Cooperation and Development. Let’s be conservative and assume that half of these individuals are receiving some kind of care now, so that we will only need 50,000.
One response to this assumption may be that we already have too many doctors. Perhaps, but the average in the much-admired France, for example, is about 30% higher per 1000 population than in the U.S., so it is likely that we will really need at least that many more doctors to handle the workload.
Here is a much more reliable report on the subject.
The reasons for the shortage of physicians in the U.S. are quite complex and, as usual, there is a component of blame attributable to Congress and Medicare.
In order to secure a medical license, one needs to graduate from an accredited medical school and then take at least a one year postgraduate residency position, although the vast majority of graduates, even those entering primary care type practices, pursue an additional 2 to 3 years of training. For some specialties of surgery or medicine, the additional post-graduate training can be 5 to 8 years.
Medicare is the largest single source of funding of graduate medical education, another name for residency training.. The Department of Veterans Affairs also finances the training of about 10% of residents. The costs of graduate medical education are financed by Medicare under two mechanisms: Direct Medical-Education payments to hospitals for a share of residents’ stipends, faculty salaries, administrative expenses, and an overhead allocation to residency programs; and the so-called Indirect Medical-Education adjustment to Medicare payments for each Medicare patient treated at the hospital. The rationale for this indirect education adjustment is the relatively higher costs attributable to the more severe degrees of illness typical of Medicare patients who require specialized services available in teaching hospitals.
In 1997, Medicare’s direct payments for graduate medical education totaled $2.2 billion — 47 percent more than in 1990. Medicare’s indirect medical-education adjustment is based on the number of full-time-equivalent residents who are being trained in the inpatient and outpatient departments of a teaching hospital. Generally, the more residents there are, the greater the payments to a hospital will be. Such payments to teaching hospitals totaled $4.6 billion in 1997 — 84 percent more than in 1990.
In an effort to cut the costs of Medicare, the Balanced Budget Act of 1997 was enacted. Among other effects, it reduced direct payments for Graduate Medical Education by $700 million and trimmed $1.1 billion per year off Medicare’s indirect teaching payments for the subsequent five years. Also, for the first time, Congress imposed a cap on the number of residents the program would support by its direct and indirect teaching payments. The idea was that fewer physicians would mean lower costs.
This was a disastrous error as we now face the aforementioned shortfall in primary care physicians for the proposed newly insured individuals in addition to a universally recognized coming shortage of all types of physicians, both primary care and specialist physicians. In proof, the new 2008 recommendation made by the governing body of the nation’s medical schools (the Association of American Medical Colleges) demands that,” serious efforts must be made to expand the number of health professionals educated to care for a population that continues to grow and whose aging will place unprecedented demands upon the health care system.”
If the argument for a wholesale revamping of American healthcare depends on the large number of uninsured, typically estimated at 45 million (although a New York Times editorial elevated the number of medically uninsured and underinsured to over 100 million), then there had better be some plan that goes along with the reform to find the 25,000 to 50,000 new physicians that will be required. And by the way, since the number of physicians retiring in the next decade will be about 25,000 per year, you can see we have a bit of a problem.
http://www.frumforum.com/the-coming-doctor-shortage
Guru
Originally Posted by northwinds
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