3 ms·

Easiest solution is to embark on a serious 10-year plan to double-and-then-triple the number of newly-created mds passing through the system. This can't be don

by frig 17y ago

Easiest solution is to embark on a serious 10-year plan to double-and-then-triple the number of newly-created mds passing through the system. This can't be done immediately -- it'd take time for institutions to ramp up their teaching staff and associated facilities -- but it could be done over time. Some federal program that'd make funds available on condition of a particular school hitting a particular # of enrollments would the simplest solution; given a choice between mad money and placating the AMA boffins most administrators would take the money. There's no real shortage of people capable of being decent physicians; most of the selectivity of medical school admissions is b/c the # of slots the schools allow is low.

matrix 17y ago
Physician supply is a long, long way down the list of fundamental issues with US healthcare. Right now, we as a nation have bigger fish to fry - such as making the moral decision on whether we as a society feel healthcare should be a right or a privilege, and getting the right alignment between economic incentives and effective healthcare.
- deleted 17y ago
  [deleted]
- frig 17y ago
  If we're talking about mass-producing medicine you need more physicians at some point. Your larger points may hold but I think you're underestimating the need for more physicians in the future. There's firstly the obvious aging-population demographic; the older people get the more health care they'll want and thus if you hold the population of physicians constant (as a % of the overall populace) the demands upon the for physicians' attention will become greater as time moves forward; you might say "so hire more nurse practitioners!" but I suspect that won't be the answer, and I think that'll be clear after the next point. The second point is that as medical knowledge has increased over the years medicine itself has gotten much more complicated. Problems that had no answer can now be examined and more-complicated disease mechanisms and cross-interactions (etc.) can be looked at. This is particularly true in gerontological settings -- old people have lots of problems mutually-compounding each other -- but it's complicated problems aren't the unique purview of the elderly. To practice future medicine well will require more time and attention on the physician's part; getting that time back in the face of increasing demand for physician's time probably requires more physicians, doing more-thorough work on fewer patients. And even in the present day most major teaching hospitals only really get by by slave-driving their residents; get rid of the residents and there's not enough doctors available at prices the institutions can afford to keep the hospitals working at full capacity.
- yummyfajitas 17y ago
  No, physician supply is a fundamental issue. The price of medicine is high in part because of scarcity: there are (doctor's working hours) x (number of doctors) doctor hours available for consumption. People desire more doctor-hours than exist, hence some rationing mechanism is needed. By increasing the number of doctor-hours (either increase number of doctors or doctor working hours) you can reduce the scarcity. You can't eliminate scarcity simply by making a moral choice.
  - nradov 17y ago
    Sure you can reduce the price of physician time by increasing the supply, but that isn't practical for several reasons. 1. The high price is largely due to the need to pay off education loans. Physicians commonly finish training $200K+ in debt. Even if there were more physicians, they would have to charge almost as much just to make ends meet. To solve that you first need to find a way to cut the price of education. 2. Very few people want to be physicians, and fewer still have the intelligence and talent to do it well. Treatment by a quack is often worse than no treatment at all. 3. The only way to get a lot more physicians in to industrialized countries is through immigration from developing countries. However the political climate has turned against immigration (I think that's a bad change, but it's unlikely to reverse any time soon). And importing physicians leaves those developing countries bereft of medical care they desperately need. 4. Most physicians already work long hours. You can't squeeze much more out of them. Or if they do work longer, quality of care suffers.
    - frig 17y ago
      (1) is easily solvable given enough political will; a federal program funding medical loans in exchange for N years of post-education service in particular hospital systems. There are successful models for this in use in the army (both at the level of things like ROTC and also at the level of becoming a doctor-for-the-army); if the federal government's role in healthcare expands a program like this producing physicians for "general service" is entirely reasonable. (2) is correct in principle but without firmer #s it is hard to say if it's materially limiting. A look at an actual chart is revealing: http://www.aamc.org/data/facts/charts1982to2007.pdf http://www.aamc.org/data/facts/charts1982to2007.pdf ...page #3 (as printed on the page) has a matriculation chart: - in the 1982-3 period 16,597 students matriculated - in the 2006-7 period 17,759 students matriculated ...which is ~7% increase of 20 years. The last page has a graduation chart which is similarly flat. By comparison, the # of full-time fall enrollees at degree-granting institutions: - in 1982: 7,220,618 - in 2007: 11,269,892 ...which is a ~50% increase over 20 years ( cf http://nces.ed.gov/programs/digest/d08/tables/dt08_188.asp http://nces.ed.gov/programs/digest/d08/tables/dt08_188.asp ). I've omitted part-timers as largely irrelevant wrt the # of future medical school students. Now it's possible that: - there's been a nearly-constant supply of students enrolled in college each year who are interested in and capable of becoming physicians - ...almost the entire 50% increase in student enrollment has been in students uninterested in medicine and/or incapable of becoming competent physicians ...but that extreme of a shift seems rather unlikely. What seems more likely is that medical schools have decided to hold class sizes mostly constant over the years, with a slight upward trend (which I'd wager is mostly accounted for by the opening of new medical schools over those decades, not by increased class size at existing institutions). If that scenario pans out -- that the pool of qualified candidates is larger than the current matriculants -- than while your point (2) is a limit on how far the supply of physicians can be increased it wouldn't be the case that we're necessarily close to that limit..
phren0logy 17y ago
This is a bad idea for a number of reasons. Why water down the quality of physicians rather than increase the number of Physician Assistants or Nurse Practitioners? They are more than capable of providing basic preventative care. They are also less expensive for the system.
- frig 17y ago
  What in what I suggested suggests that the quality of physicians would be materially watered-down. It will be your word against mine but I assert that there are plenty of people fully capable of becoming competent physicians getting turned away from medical school each year. They are turned away because the schools only have N slots per year and the turned-away applicants are not amongst the best N applicants that year. It's unclear how far down the applicant pool you could go before you start allowing in the fundamentally incapable, but I have a hard time believing the current matriculating class size is anywhere near that threshold. I don't disagree the world could clearly use more NPs. The issue I can foresee though is that medicine is getting ever more complicated and specialized with time; there's an upper limit on what NPs are capable of covering after which point you need physicians.

by frig 17y ago

matrix 17y ago

Physician supply is a long, long way down the list of fundamental issues with US healthcare. Right now, we as a nation have bigger fish to fry - such as making the moral decision on whether we as a society feel healthcare should be a right or a privilege, and getting the right alignment between economic incentives and effective healthcare.

deleted 17y ago
[deleted]
frig 17y ago
If we're talking about mass-producing medicine you need more physicians at some point. Your larger points may hold but I think you're underestimating the need for more physicians in the future. There's firstly the obvious aging-population demographic; the older people get the more health care they'll want and thus if you hold the population of physicians constant (as a % of the overall populace) the demands upon the for physicians' attention will become greater as time moves forward; you might say "so hire more nurse practitioners!" but I suspect that won't be the answer, and I think that'll be clear after the next point. The second point is that as medical knowledge has increased over the years medicine itself has gotten much more complicated. Problems that had no answer can now be examined and more-complicated disease mechanisms and cross-interactions (etc.) can be looked at. This is particularly true in gerontological settings -- old people have lots of problems mutually-compounding each other -- but it's complicated problems aren't the unique purview of the elderly. To practice future medicine well will require more time and attention on the physician's part; getting that time back in the face of increasing demand for physician's time probably requires more physicians, doing more-thorough work on fewer patients. And even in the present day most major teaching hospitals only really get by by slave-driving their residents; get rid of the residents and there's not enough doctors available at prices the institutions can afford to keep the hospitals working at full capacity.
yummyfajitas 17y ago
No, physician supply is a fundamental issue. The price of medicine is high in part because of scarcity: there are (doctor's working hours) x (number of doctors) doctor hours available for consumption. People desire more doctor-hours than exist, hence some rationing mechanism is needed. By increasing the number of doctor-hours (either increase number of doctors or doctor working hours) you can reduce the scarcity. You can't eliminate scarcity simply by making a moral choice.
- nradov 17y ago
  Sure you can reduce the price of physician time by increasing the supply, but that isn't practical for several reasons. 1. The high price is largely due to the need to pay off education loans. Physicians commonly finish training $200K+ in debt. Even if there were more physicians, they would have to charge almost as much just to make ends meet. To solve that you first need to find a way to cut the price of education. 2. Very few people want to be physicians, and fewer still have the intelligence and talent to do it well. Treatment by a quack is often worse than no treatment at all. 3. The only way to get a lot more physicians in to industrialized countries is through immigration from developing countries. However the political climate has turned against immigration (I think that's a bad change, but it's unlikely to reverse any time soon). And importing physicians leaves those developing countries bereft of medical care they desperately need. 4. Most physicians already work long hours. You can't squeeze much more out of them. Or if they do work longer, quality of care suffers.
  - frig 17y ago
    (1) is easily solvable given enough political will; a federal program funding medical loans in exchange for N years of post-education service in particular hospital systems. There are successful models for this in use in the army (both at the level of things like ROTC and also at the level of becoming a doctor-for-the-army); if the federal government's role in healthcare expands a program like this producing physicians for "general service" is entirely reasonable. (2) is correct in principle but without firmer #s it is hard to say if it's materially limiting. A look at an actual chart is revealing: http://www.aamc.org/data/facts/charts1982to2007.pdf http://www.aamc.org/data/facts/charts1982to2007.pdf ...page #3 (as printed on the page) has a matriculation chart: - in the 1982-3 period 16,597 students matriculated - in the 2006-7 period 17,759 students matriculated ...which is ~7% increase of 20 years. The last page has a graduation chart which is similarly flat. By comparison, the # of full-time fall enrollees at degree-granting institutions: - in 1982: 7,220,618 - in 2007: 11,269,892 ...which is a ~50% increase over 20 years ( cf http://nces.ed.gov/programs/digest/d08/tables/dt08_188.asp http://nces.ed.gov/programs/digest/d08/tables/dt08_188.asp ). I've omitted part-timers as largely irrelevant wrt the # of future medical school students. Now it's possible that: - there's been a nearly-constant supply of students enrolled in college each year who are interested in and capable of becoming physicians - ...almost the entire 50% increase in student enrollment has been in students uninterested in medicine and/or incapable of becoming competent physicians ...but that extreme of a shift seems rather unlikely. What seems more likely is that medical schools have decided to hold class sizes mostly constant over the years, with a slight upward trend (which I'd wager is mostly accounted for by the opening of new medical schools over those decades, not by increased class size at existing institutions). If that scenario pans out -- that the pool of qualified candidates is larger than the current matriculants -- than while your point (2) is a limit on how far the supply of physicians can be increased it wouldn't be the case that we're necessarily close to that limit..

phren0logy 17y ago

This is a bad idea for a number of reasons. Why water down the quality of physicians rather than increase the number of Physician Assistants or Nurse Practitioners? They are more than capable of providing basic preventative care. They are also less expensive for the system.

frig 17y ago
What in what I suggested suggests that the quality of physicians would be materially watered-down. It will be your word against mine but I assert that there are plenty of people fully capable of becoming competent physicians getting turned away from medical school each year. They are turned away because the schools only have N slots per year and the turned-away applicants are not amongst the best N applicants that year. It's unclear how far down the applicant pool you could go before you start allowing in the fundamentally incapable, but I have a hard time believing the current matriculating class size is anywhere near that threshold. I don't disagree the world could clearly use more NPs. The issue I can foresee though is that medicine is getting ever more complicated and specialized with time; there's an upper limit on what NPs are capable of covering after which point you need physicians.