Posted on 07/16/2006 11:44:58 AM PDT by neverdem
CAN we cure our ailing health care system by sending in more doctors? That is the treatment prescribed by the Association of American Medical Colleges, which has recommended increasing the number of doctors they train by 30 percent, in large part to keep up with the growing number of elderly patients. But the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured — cannot be solved by more doctors. In fact, that approach, like prescribing more drugs for an already overmedicated patient, may only make things worse.
Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists, according to The Dartmouth Atlas of Health Care, a study of American health care markets (for which I am an investigator).
The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?
Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors...
(Excerpt) Read more at nytimes.com ...
I'm not able to read the whole article. What, exactly, are we trying to get at here. Help me out please.
Much of the medical establishment wants to keep med school enrollment low in order to keep doctors' salaries high. The NYT article's point seems to be that more doctors doesn't necessarily equal better care for the elderly or greater longevity. Fair enough, but if U.S. medical school enrollment is just dandy, then how come 40,000 doctors from India are able to come here and find work? Obviously, domestic enrollment isn't sufficient to meet market demand.
But that is exactly it - it is market demand, with no results. Most medical interventions in the end stages of life do nothing, other than comfort the patient.
Close allegory.
Maybe, but why focus just on end-of-life care? I'll bet there are other areas of medical practice where a greater number of physicians would make a substantial difference. I'd be interested in seeing some statistics on the correlation between number of pediatricians in a region and infant mortality, for example.
That ignores all the American docs who retire as early as possible because the gov't has made practicing medicine too much of a hassle.
Too many doctors? LOL - Right now half the doctors in this town are on vacation. Don't make the mistake of getting sick or needing a prescription refilled on a friday. All gone for the weekend. All the receptionists go to school to learn one reply: Have you tried the emergency room?
You got it!!! Most physicians I talk to want to get the heck out. Training a greater number of less qualified people is absolutely the wrong prescription for our health care system.
I would like to see such, too. Add in statistics that corrolate the number of doctors to the incidence of asthma. [Hint: everyone with asthma was born in a hospitol.]
"the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured"
This is all wrong. The most serious problem is that medical care is now delivered via a communist system. People have given up their freedom of choice, thinking medical care will somehow be provided by the government, or their employer, or Santa Claus. Doctors are now employed by the government or by insurance companies, who tell doctors what to do. Individuals do not have enough incentives to pay attention to their own health. That's why we have high rates of obesity, diabetes, heart disease, cancer, etc. - most of it self-inflicted by people over-eating, smoking, drinking, not and exercising. Socialized medicine is the problem, not the solution. No one is "entitled" to health care, anymore than housing, food, retirement income or vacations.
pity.
The problem is not "too many doctors". It is "too many doctors concentrated in too small an area". There are wide areas of the country that have very low concentrations of population, and are badly underserved in terms of medical services. There are also urban areas that are underserved as well. In what seems to be a counterintuitive finding, where doctors are highly concentrated, medical costs skyrocket, the forces of free market notwithstanding.
Doctors of medicine in high-concentration areas tend to go for very narrow specialties, which also tends to make their services more unique, and therefore, more valuable. Add to that the cost of simply doing business as a physician, in terms of training, staff, facilities and operational expenses, and the simple old country doctor of Norman Rockwell nostalgic memory becomes ever more a quaint fairy tale.
No wonder doctors no longer make house calls.
I've worked with medical residents. They don't give a damn about the patients. Just about how much money they're going to make once their residency is finished.
All of whom must practice under the supervision of a doctor.
I'll take a doctor anytime over a not even close to a doctor nurse.
I've been in health care all my adult life - 10 years in administration -- and I'm here to tell you there is, in economic terms, a SEVERE shortage of physicians, especially specialists. And the rise in mid-level providers is a response to thos chronic shortage, and perfectly sensible natural step for any highly technical discipline. New professions are always being created to cope with the explosion of knowledge.
100 years ago a chunk of the discipline was pealed off and handed to another profession, which we how know as nurses. This is another similar wave; the truth is that about 50% of what most docs do can by done by a PA or a NP -- freeing up the MD to focus on the tough stuff.
And only as liberal could think that high prices will improve if the government takes over and CURTAILS SUPPLY. It takes a liberal mind to believe that sort of economics.
A related problem is that most health care is above the ability of the average person to make informed choices. This doesn't mean they're stupid (although some are), but simply that the treatment is so technical that the average person without a medical background has a very difficult time determining which treatment method is best, or if treatment is necessary at all.
I use glasses, now. I can go to a standard optometrist, pay $100 for an exam, and get contacts for a year, walking out with a bill for a couple of hundred payable in full by me at time of service. My medical doesn't cover glasses and standard eye exams. If, OTOH, I go to an ophthalmologist, although he will charge more, I make a small co-pay, and insurance covers the rest. Greater cost, but less expense for me. It's only my hard-headedness that keeps me using the optometrist.
Not me. I get a lot more thorough exam from a NP or PA simply because they are allotted the time for it.
Table 2 average hours per week
Don't forget many work for more hours than than average and also get less income.
like arranging tee-times, getting ahold of the stockbroker, making sure the dogsitter shows up before we leave for Tahoe....
Around here, the standard answer after hours or on weekends is: "If you have an emergency, dial 911."
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