Shortage of Doctors an Obstacle to Obama Goals

Posted by Kendall Harmon

The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada.

Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”

Even people with insurance have problems finding doctors.

Read it all.

Filed under: * Culture-WatchHealth & Medicine* Economics, PoliticsPolitics in GeneralOffice of the PresidentPresident Barack Obama

Posted April 28, 2009 at 8:46 am [Printer Friendly] [Print w/ comments]

1. A Floridian wrote:

His plans to force physicians and nurses to commit abortion against their consciences may cause him trouble where it matters most…God will not bless Obama’s presidency or his programs. 

Obama said yesterday:
“It is the grimmest of ironies that one of the most savage, barbaric acts of evil in history began in one of the most modernized societies of its time, where so many markers of human progress became tools of human depravity: science that can heal, used to kill; education that can enlighten, used to rationalize away basic moral impulses; the bureaucracy that sustains modern life, used as the machinery of mass death, a ruthless, chillingly efficient system where many were responsible for the killing, but few got actual blood on their hands.”

Does he really comprehend what he just said?

April 28, 9:49 am | [comment link]
2. robroy wrote:

Want to make more people go into primary care? Make it so they life doesn’t totally stink. None of my colleagues in primary care are happy. Years of reduced payment and increasing paperwork have taken their toll. I can’t imagine seeing patients in an assembly line fashion.

Here is a big problem that will become much bigger:

“If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

Joint replacement surgery is growing exponentially. These joints have a finite lifetime and will need to be replaced - a much more complicated surgery. A significant fraction will become infected which often requires extended hospitalization and IV antibiotics (leading to more superbugs). My conclusion: Joint replacement surgery will bankrupt us all.

April 28, 9:54 am | [comment link]
3. Ralph wrote:

The Clinton emphasis on primary care, and the balanced Budget Act have done a lot to damage subspecialty care in the United States.

Yet, Americans demand subspecialty care. If Mr. Obama gets asthma, diabetes, prostate cancer, or a number of other common ailments - he will be seen by the finest subspecialists in the country.

If I got leukemia, I wouldn’t DREAM of going to a primary care physician for therapy.

We do need more doctors. Someone simply has to come up with a way to pay for their basic medical education (medical school), and their graduate medical education (residencies and subspecialty fellowships). That will have to be the federal government.

April 28, 9:55 am | [comment link]
4. Dave B wrote:

I agree with #2 robroy, and #3 Ralph, the only way socialized medicine can work is rationing.  Krauthammer had a really good editorial on this and he used to be a surgeon. Right now there is something for everybody in health care and everything for some folks.  With rationing there is less and less for more and more and nobody gets everything!

April 28, 11:58 am | [comment link]
5. Jeffersonian wrote:

Calling Dr. Galt, Dr. John Galt.

April 28, 1:53 pm | [comment link]
6. Sarah1 wrote:

Oh my—I wonder why on earth there is a shortage of doctors?

What has possibly gone wrong?  Who wouldn’t want to go learn to be a doctor and work for the government?

The shortage of doctors is such a Deep Mystery.

April 28, 1:54 pm | [comment link]
7. Jeffersonian wrote:

Maybe it has to do with no kid ever growing up aspiring to work at the DMV, Sarah.

Nationalized car companies, banks effectively nationalized, tentacles wrapping around the health care industry…my, aren’t things going swimmingly for the political class?

April 28, 2:05 pm | [comment link]
8. Frances S Scott wrote:

I agree in part with Robroy.  We lost our excellent primary care physician because low insurance payments from patients didn’t cover the cost of staff to handle the increased paperwork.  However, 20 years ago, at age 57,  my husband had hip replacemnt surgery on his right hip (foot ball injury in college).  That surgery will not have to be repeated in this lifetime, nor needed in the next.  He had his left hip replaced last week and is recovering nicely.  Both times he continued to walk and swim up until his surgery, even though he did that for a full year with only bone on bone in the hip joint. I think every hip replacement case needs to be judged on its on merits. 
Frances Scott

April 28, 2:14 pm | [comment link]
9. Country Doc wrote:

Laws that have been validated over and over:
1.  Price controlls equal shortages.
2. Socialism equal poverty.
3. Big government equals loss of liberty.
4. Biological creatures withdraw from painful stimuli.
5.  Hassels from government, lawyers, demanding patients equal doctors avoiding these situations and changing professions, slacking off, or retiring.
The American people have decided to send the money to other things rather than medical care and physician reimbursment.
They will get what they support and less of what they don’t support.


April 28, 2:26 pm | [comment link]
10. Dilbertnomore wrote:

#5, can’t seem to find Dr. Galt. He was here yesterday working hard and was marvelously dedicated. We assume he is sick at home or on a well earned vacation. Hospital management are insistent he will be back to work his magic to solve the problem of declining numbers of doctors. Meanwhile all we can do is further ration the care the remaining doctors can provide. We all must just tighten our belts. But the good news is that everyone is in the same boat and has perfectly equal access to the limited medical care available. Except for the truly important people leading the government whose needs certainly must be covered to they can look after the rest of us.

Elections produce consequences. The decline of our health care will be a big consequence. Nice job 53%.

April 28, 6:01 pm | [comment link]
11. Dave B wrote:

Frances S Scott, I do a lot of anesthesia for hip surgeries and total joint replacements, it is my understanding that total joint prostheses from that period (20 years ago) lasted about 15 to maybe 20 years.  It is my understanding that total joint surgery used to be put off as long as possible to reduce the risk of doing a revision.  Revison of total joints can be really tough surgeries. I would like others to comment, my experiance maybe limited and I am not an orthopedic surgeon.

April 28, 6:49 pm | [comment link]
12. Mitchell wrote:

If we solved the compensation issue, how would we get more doctors?  It was my understanding that all US Medical Schools were operating at full capacity and were turning away about half of the applicants who meet their basic criteria for admission.

April 29, 11:27 pm | [comment link]
13. Country Doc wrote:

Mitchell, 40 years ago there were 20 applicants for each medical school slot.  Today there are only two.  This does not mean that the second applicant was left out since most students apply at multiple schools.  Also, among the doctor graduates, if the primary care fees were raised, then many who are in the oversupplied specialities would change to primary care which is in free fall.  There are many doctors who retire earlier or drastically cut back on their work load and sort of coast in there prime years.  The work force would be more robust and productive.  We know the trajectory medicine is going now.

April 30, 12:54 am | [comment link]
14. robroy wrote:

Dr. Hari Parvataneni, an assistant professor of orthopedic surgery at the University of Miami School of Medicine, said that the average joint replacement lasts 20 years, so as more younger people are having joint replacement surgery, the need for surgery to replace replacements will also grow.

“As the burden of joint replacements increase at a phenomenal rate, the burden of revision procedures increases,” Parvataneni said. “Some of these revision procedures will require two to three times the cost of the primary implant, two to three times the clinical time of surgeons, but they only pay 20 percent more,” he said. So, there are even fewer surgeons doing complex revisions, he said.

Frances, I am not saying that it isn’t a fantastic surgery. It is a medical miracle. I am just saying that the costs are exploding when funding is declining.

Only a few years ago, between 300,000 and 350,000 knee replacement surgeries were being done. Today, that number has risen to a staggering 500,000. And 10 years from now, experts estimate there could be as many as 3.2 million annual knee replacement surgeries.

While knee replacement surgery does have a positive impact on a patient’s quality of life, Blaha and other experts in the field worry that the demand for new knees will far outpace the availability of surgeons trained to perform the procedure.

“A recent study that looked at trends in joint replacement found that although the number of orthopaedic specialists who do joint replacement is going to increase by about 2 percent, the need for orthopaedic surgeons is going to increase by 500 percent,” he says. “That’s a problem of epic proportions.”

April 30, 10:03 am | [comment link]
15. Mitchell wrote:

So are you saying there are some medical schools that could take more students, but do not have enough qualified applicants?  Because I was told by a medical school administrator, that he thought all of the schools had more applicants than they could accomodate.

April 30, 11:17 am | [comment link]
16. Mitchell wrote:

I guess my point is we seem to look at the medical profession as something that we as a nation need to help manage; such as making sure doctors are compensated properly to take specific jobs.  This is an invitation for government involvement and ultimately government sponsored health care. 

Should we not look at this as a traditional free market, supply side problem?  You say the number of applicants for available slots is to 2 to 1.  As a business man if I had 2 times as many customers as I could handle, I would be looking to expand.  If we dramatically increased the number of Medical School slots available, the increase in the number of doctors graduating would increase competition; thereby driving down the compensation rate of the specialities and requiring more doctors to go into primary care to find employment in their chosen profession.  An additional benefit is competition among the medical schools would drive down the cost of medical education.  This is how the free market would handle this problem. 

  I don’t know how much additional capacity we need to construct, but free market principals would say build until you have capacity to handle all qualified applicants.  From your numbers that would mean we could double the available slots.  I doubt that is achievable, but surely we could increase the number by 50% to 75%. 

  For some reason, however, our country has chosen to artificially restrict the supply of doctors by not building medical schools to meet the demand for medical education.  I am not saying that is the only inefficiency in the current system, but I am saying it is one.

  The government should be encouraging and providing funding for the construction of new medical schools.  That would have a stimulus effect by employing construction workers sidelined by the housing collapse and increasing the sale of building supplies, would increase the supply of doctors, and decrease the cost of medical care.

April 30, 12:06 pm | [comment link]
17. Country Doc wrote:

Mitchell, like I said, students apply at multiple schools.  We would need to know out of all students who apply to all schools how many did not find a slot somewhere.  It would be like counting how many came into your store, but did not make a purchase as an index of the demand.  Also, probably many who applied really don’t qualifi for a slot.  I remember in my class there were several who got in at the last minute, but most did not finish the first year.  I think if there were a large supply of truly qualified who could not get in then more schools would be built or others expanded.  More of our best are choolsing to go into other fields that formerly would have delighted to be a physician.  Now they would not touch the job.  With the increased demand,  I think we will see a “dumbing down” of the practitioners.  We already are running out of nurse practitioners so soon nurses will be doing more, then aids, then some sort of technicians, etc.  In Russia physicians have equivalent to a masters degree.  There can be much more efficiency in our system, but this is hindered by the government regulations and legal system pestering.  I don’t see much leadership to figure out the problem.  Most doctors feel we are on a run away train and a crash is inevitable.  Generally we doctors aren’t asked to provide solutions.  We are out of the loop.  Other than being thankful for being called to the privilege of helping my fellow man in healing and serving the Lord in this profession, I would not recommend anyone going into medicine now.  Without the direct leading of the Lord into medicine, I would have rather done something else.  I would have had more fun and less stress.  He will have to give me strength to continue.

April 30, 11:42 pm | [comment link]
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