Posted on 12/04/2013 6:40:09 PM PST by Innovative
The rise of nonphysician providers will enable more team care. Skilled health aides will monitor patients at home and alert a doctor if certain medical parameters decline. Nurses will provide wound care to diabetic patients, adjust medications like blood thinners and provide the initial management of chemotherapy side effects for cancer patients. Pharmacists will provide more counseling and urgent care. Physicians will remain essential to the proper diagnosis and treatment of disease, but will be backed up by teams who will help manage the more routine features of chronic illness.
(Excerpt) Read more at nytimes.com ...
RE: “No, There Won’t Be a Doctor Shortage”
Just an appointment shortage.
That’s also discounting bank loans, personal loans, credit cards, talking with the doctor and working out a payment plan. The only issue is when someone decides not to repay.
There’s still a world of difference between borrowing a hundred bucks from family and paying them back, vs getting public assistance or even just going into the ER, accepting the care, and then refusing to even try to pay.
Just a doctor-with-brain shortage.
The politicos and their families will not experience any shortage. Have you figured out that they hate you and your family? They want your money...but you are nothing.
We are not THAT far apart: I waited to have a family of my own until I was (I thought) reasonably financially secure. (Steady job for over 10 years, good company, good $$ in the bank. Budget frugally, invest carefully, keep family small, marry a "low maintenance woman"...well, ok, lower than average...) If most conservatives followed my family size example, we'd be a 10% permanent minority in a couple generations.
Even with all that, it's amazing how fast it (a middle class family's finances) can break down. But if everyone feared that excessively, there'd be no families!
Now, to respond more on-topic to the "supply of doctors question" and your concerns:
I try to keep in mind that health care has (at least in terms of cost) "gone bad" over a long period. I am under no illusions that it can be fixed in under a generation, though I think substantial progress could be made in 10-15 years, especially in terms of "supply of doctors."
"Brains, means, and desire."
Let's take those one at a time.
"Brains" really has two components: Intrinsic intelligence, and pre-college education, especially education up to grade 6. Intrinsic intelligence is no problem, though the supply may be somewhat hidden by our present education system. Early education, da, that appears problematic, but from what I've seen in our local home schooling group, if one could add 20% of that group and 5%(?) of the kids in good private schools to the kids going into medicine already, from all sources (not ALL public schools are atrocious yet, at least in the sense of turning out capable graduates)... well, given the increasing numbers of home schooled kids alone, I think the "enough kids with the smarts to be doctors" problem is easily answered. We are not talking big numbers here - in 2005 the U.S. was (successfully) training ~25,000 doctors a year. That's probably up, but I'm sure it has not gone up a lot.
"Means" / the high cost of medical school: That can be addressed though competition and opening more med. schools or enlarging existing med. schools. This is (presently) limited mostly by politics. I'd rather not have to have more tax money go into funding this, however, there IS such a thing as a good investment, even by the government, once in a while.
Keep in mind that even now there are roughly 2 applicants for every medical school opening in the US -- one would expect that most of those applicants DO have the means. "Desire"? That gets back to early years education*, and also very much to letting doctors doctor, and either getting rid of a lot of the crap (paperwork, lawsuits, etc.) and / or shifting away or minimizing a lot of it. Get being a doctor back to being an profession that doesn't have more negatives than positives, for God's sake.
*Maybe not just early years either? And whatever happened to doctors as decent professional hero types on TV shows you'd actually want your kids to watch? Ok, so you're not gonna get the alphabet letter networks to do it? Get Christian channels & PBS-per-Congressional-directive to do it. Distribute the shows free via the Web. Or produce "family" DVD movies or series with doctors as admirable characters instead of the drecchh presently on most shows. It can be done - heck - Star Trek alone generated many thousands of engineers, and probably some "wanna be" doctors as well.
None of this will work, of course, if you don't get rid of the biggest impediment on the new supply side as well. Better than me rambling on, these articles pinpoint the real culprit: The medical organizations who limit the number of residencies:
http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/
http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm
Both articles have their problems, but the basic data is correct. There is really NO insurmountable reason, except perhaps for the politics, that a wealthy country of 300+ million people can't train 40,000-50,000 great doctors a year.
How?
I guess they’ll pick your profession for you like China or East Berlin does/did?
The NURSES will be doing EVERYTHING andwe all know there is a NURSE SHORTAGE....at least ones that can speak ENGLISH!!
The Dr. Will get used to it.
CVS already has quick clinics staffed by nurse practitioners.
Walmart actually started to compete with CVS. There are now several health systems that have placed clinics in Walmart. http://www.walmart.com/cp/Walmart-Clinics/1078904
“They’ve been pressuring me to allow healthcare workers to make home visits for a couple of years now.
It ain’t gonna happen here!”
Probably what they really want to do is look to see if you have any guns at home, they couldn’t care less about YOUR health...
I think I read somewhere that they are instructed to do that, just like your doctor is supposed to ask you if you have any guns at home.
Kozak, Sir, please don’t take any of this the wrong way. In fact the first thing I’d say is God Bless You! for being an ER doc. That’s gotta be a tough job. And as an engineer, I can certainly understand situations when “simple isn’t simple.”
From my viewpoint as a health care consumer, or, more precisely, members of my family have really been consuming lately, it seems that there is a serious shortage of Primary Care Physicians and access to them. I don’t think it is just my location; I hear the same from many friends around the country. Basically, it is nearly impossible to get in to see one’s PCP in under a week or two. So, then the only recourse if something serious comes up and needs immediate attention is to go to the ER. Then one is right into that “fragmentation of care” that you speak of. Even if one has that list you speak of, that’s not the same thing as having the doctor who’s in charge of your overall care and has (hopefully) been in that position for a while, running the show. To me, a very crude analogy would be me looking at the CAD drawing (rendering) our CAD guy at work made up, of a complex prototype, and looking at simulations of its performance, vs. me having the actual prototype “in hand” to work with and test for a prolonged period.
I also wonder how many people get so frustrated at the difficulty of seeing a PCP that they eventually make the ER or walk-in clinic their first choice in many situations.
did you hear about the “group appointments”?
Yeah, like, everyone that needs a prostate exam will be grouped up in a room and the doctor will do everyone during the same visit.
“How’s it going over there, Charlie?”
“You completely miss the point. It takes 10 years of training to be able to figure out when it’s NOT “ just simple sutures, or a sinus or bladder infection.”
EXACTLY!!!
Misdiagnosis and severe injuries and illnesses will be rampant precisely because untrained people will treat everything as “minor” and by the time it becomes abundantly clear it’s not, it will be too late in some cases.
Uh yes there already is. It is already difficult for me to hire new physicians, and I live in a highly desireable area to practice.
nope. Just see your friendly local pharmacist. They will take care of it......
“I *refuse* to mooch.’
You are NOT “mooching” when you pay medical insurance and expect to get proper care.
If you CHOOSE to take your chances and NOT buy insurance, that’s your choice — not that you will have any choices under Obamacare.
You never know when you may be in an accident or get an illness that is curable, but needs serious medical care.
“If we wanted to lower health care costs, it would probably help to encourage MORE capable people to become (and stay) physicians”
AND to require LESS bureaucratic paperwork for physicians, rather than more, so they can spend their time practicing medicine, instead of paperwork.
Amen. And how many times a PA or NP treats something “simple” by cookbook approach and totally misses the critical AS murmur, or the underlying cancer when it could be treated early or.....
Hospital ships, and our docks manned by DHS/NSA security to keep people from them.
“My own doc who is about ready to retire, and I have seen for almost 30 years, is not so optimistic.”
Same here. My M.D. just went into semi-retirement-——just kept about 20% of her patients (the oldest ones)
She looks happy and relaxed and gives the patients she kept,including me,lots of time.
.
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