lol @ "doctor shortage"

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Originally Posted by SpecterGT260

I don't believe you really think it is appropriate to open the medical profession and let the consumer decide who provides care. This is a complete parallel to opening arms sales. Many things can be used or misused. The question is where do we draw the line in terms of how severe consequences of misuse are.

Not sure where to draw the line, but think we definitely have things locked down a bit too tightly.

Originally Posted by Shnurek

About $500 a year for ODs for $1 million/$3 million malpractice coverage. One OD missed glaucoma, didn't have insurance and got his butt batted with an aluminium baseball bat by the lawyers.

Interesting, I really didn't know that OD's had full independent prescription privileges. Kind of wonder why more OD's don't just do a kind of general family practice on the side for people who want a one-stop-shop at their optometrist visit (refill the blood pressure meds, antidepressants, etc.) Maybe Medicare/private insurance doesn't cover that kind of visit at an OD? That would be the other issue for midlevels to get past, even if we open up prescription privileges for all of them, it doesn't mean Medicare/Medicaid/private insurance has to pay (or pay equally) for their prescription services.

Originally Posted by SteinUmStein

Interesting, I really didn't know that OD's had full independent prescription privileges. Kind of wonder why more OD's don't just do a kind of general family practice on the side for people who want a one-stop-shop at their optometrist visit (refill the blood pressure meds, antidepressants, etc.) Maybe Medicare/private insurance doesn't cover that kind of visit at an OD? That would be the other issue for midlevels to get past, even if we open up prescription privileges for all of them, it doesn't mean Medicare/Medicaid/private insurance has to pay (or pay equally) for their prescription services.

I think they have limited prescription abilities (like neuropsychologists).

Originally Posted by VisionaryTics

I think they have limited prescription abilities (like neuropsychologists).

Ah, that makes more sense. I was referring in my earlier comment to midlevels being given full, unrestricted prescription abilities (as a physician has). I would guess that OD malpractice insurance is probably cheaper because there aren't as many dangerous meds or med combinations that they can prescribe.

Originally Posted by SteinUmStein

Interesting, I really didn't know that OD's had full independent prescription privileges. Kind of wonder why more OD's don't just do a kind of general family practice on the side for people who want a one-stop-shop at their optometrist visit (refill the blood pressure meds, antidepressants, etc.) Maybe Medicare/private insurance doesn't cover that kind of visit at an OD? That would be the other issue for midlevels to get past, even if we open up prescription privileges for all of them, it doesn't mean Medicare/Medicaid/private insurance has to pay (or pay equally) for their prescription services.

Originally Posted by SteinUmStein

Ah, that makes more sense. I was referring in my earlier comment to midlevels being given full, unrestricted prescription abilities (as a physician has). I would guess that OD malpractice insurance is probably cheaper because there aren't as many dangerous meds or med combinations that they can prescribe.

We can Rx orals in 47/50 states but they have to be indicated for an eye condition. Yes, we do not have full unrestricted Rx privileges in many states but in many other states such as NJ (closest one to me) ODs can Rx anything they would ever need. Narcotics we can Rx in I think around 43 states now but again the temporal aspect and the types of drugs that can be rx'd is regulated on a state by state basis. Some states we can basically do whatever we want, with no time limitations, no drug exclusions (except for ones not indicated for an eye condition) and no referrals mandated but those states are not currently the majority.

Some ODs have actually suggested on getting on the general primary care bandwagon but we just love our eyes and rather troll the ophthos by striving for a dental-like educational model and asking for surgical privileges.

I don't blame OD's for going for the jugular with surgical privileges, so to speak. Opthy is a pretty sweet gig, and if optometrists can get in on that action there will be quite a few less optometrists looking for jobs. There will also be quite a few very pissed off opthos.

Some places have more or less specialists but primary care has at worst.. a solid job market and at best areas that are dying for doctors. This runs consistent throughout all of north america as well.

Originally Posted by Knicks

For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, .

so you are telling me that the physician shortage is perhaps compounded by a residency spot shortage?

i am the most surprised person. nobody has ever been as shocked by common sdn knowledge as me

Originally Posted by johnnydrama

Not sure where to draw the line, but think we definitely have things locked down a bit too tightly.

I disagree based on the following argument:

IF
and individual's scores are correlated with a level of professional achievement (i.e. MD vs PA)
and IF
an individual's scores are correlated to that individual's abilities
and IF
an individual's abilities are correlated inversely to the likelihood of harming a patient
THEN
physicians are the least likely to harm a patient based on outcomes of standardized testing.

Yes, there are SOME THINGS that physicians do that could be done by your local village idiot. That isn't really what is on the table here. Again, to the analogy to arms sales: BB guns and nukes are related in terms overall umbrella topic of weaponry. So does the fact that a BB gun is not particularly harmful stand as an appropriate argument to unrestrict nuke sales? Medicine is not unique in restricting access to materials, techniques, and information. This does not make it appropriate to cry "monopoly!" as if we are just hoarding for our own benefit. The "hoarding" of medicine by doctors is every bit as much for the good of the patient. Any and all of the techniques at risk of being taken over by mid-levelers arent exactly things that physicians are lining up to do anways - they do not bill out well and do not constitute large job security. If I had reasonable hope that the average RN had the ability (which is separate and distinct from the training which is also lacking) to handle solo work I wouldn't have a problem. but based on the logic above and a nation-wide sample size: if we open the doors like this, simply going by statistical inevitability, someone somewhere WILL die as a result of it.

IBT-asinine arguments of triage, trade off, and current medical shortcomings
This is not fear mongering. I just cannot justify or rationalize a point of view that acknowledges that physicians, who by any measure are the most well equipped to provide healthcare in a safe manner, are still fallible - and the "fix" is to open the markets to a group of people who are arguably more likely to screw up.

I believe I was mainly referring to prescriptions re: things that are too locked down by physicians.

There are many cases where requiring someone to see a physician prior to getting a prescription is really just exploiting a government-enforced monopoly. Same with many blood tests.

Which prescriptions would you have turned OTC? I will agree that there are some. but I think it is more of an issue of "where do we draw the line" rather than some monopoly/conspiracy thing

Originally Posted by SpecterGT260

Which prescriptions would you have turned OTC? I will agree that there are some. but I think it is more of an issue of "where do we draw the line" rather than some monopoly/conspiracy thing

I lived for several years in Africa. Health care there is generally not very good, but one thing that I really liked about it was the generally ease of care, often without any involvement of an MD. I could get nasty diarrhea, walk into a clinic, tell the receptionist I wanted a stool test, put some poop into an empty matchbox, and 10 minutes later find out I had amoebas. I'd walk next door to the pharmacy, tell them I have amoebas, and walk out with tinidazole. There'd be no appointments, and no prescriptions. The total amount of time this takes is about half an hour, and the total cost is less than 5 bucks.

If I had amoebas in the US, I'd have to schedule an appointment with my PCP, who might not have an opening for weeks, come in, talk about my symptoms, submit a stool sample, then go home and wait to hear the results a few days later, then probably come back in to get a prescription for the meds. And the whole time this is being delayed, there's a small, but non-zero risk of the amoebas invading the intestinal wall. This is the main benefit for having stuff not be monopolized by physicians. It allows for much easier, prompter, and faster care, which often means better care.

"Where do we draw the line" is the question, and I don't have a complete answer, but I think we would do well to open things up a bit more, and not try to lock everything down under our own control so much.

Originally Posted by SpecterGT260

Which prescriptions would you have turned OTC? I will agree that there are some. but I think it is more of an issue of "where do we draw the line" rather than some monopoly/conspiracy thing

I think the best example would be SSRIs and psychiatrists.

Some psychiatrists refuse to prescribe more than a month or so of SSRIs at a time to keep their patients coming back for expensive counseling sessions.

For blood tests, I think people should be able to get basic screening tests without seeing a physician first.

It is always a question of where to draw the line, but I think we're still too paternalistic in many cases.

Availability of meds is often related both to efficacy and chance of negative side effects. The oral polio vaccine was largely abandoned after incidence dropped significantly for an inactivated vaccine which carries a lower risk. When we have a large population with need of treatment, higher risks are acceptable (i.e. amoebas in africa). Since amoebas are rare in the US it makes less sense for patients to have open access to such drugs without the go-ahead by a physician. SNAIDs are always brought up in this argument - and are subject to the same rules. Yes, they cause a lot of harm each year. however the risk/need/use ratio (however that works out) is such that it is still acceptable to give them OTC. The fact that water toxicity is an actual thing should be understood as a point which invalidates arguments of "well people hurt themselves with OTC drugs" when it comes to talking risk of prescriptions. Just because someone CAN hurt themselves doesnt mean that everything with risk should be opened up. This is all on a spectrum, and things that fall behind the line do not support an argument for conspiracy/monopoly.

Originally Posted by johnnydrama

I think the best example would be SSRIs and psychiatrists.

Some psychiatrists refuse to prescribe more than a month or so of SSRIs at a time to keep their patients coming back for expensive counseling sessions.

For blood tests, I think people should be able to get basic screening tests without seeing a physician first.

It is always a question of where to draw the line, but I think we're still too paternalistic in many cases.

I dont have much experience with SSRIs. However I am pretty sure that self-administration of them can lead to more harm than good. I actually just went over a lecture on serotonin toxicity - but aside from that screwing with brain chemistry can lead to effects opposite than what is desired. Monthly visits to a shrink suck, but I don't think they are without merit.

Originally Posted by SpecterGT260

I dont have much experience with SSRIs. However I am pretty sure that self-administration of them can lead to more harm than good. I actually just went over a lecture on serotonin toxicity - but aside from that screwing with brain chemistry can lead to effects opposite than what is desired. Monthly visits to a shrink suck, but I don't think they are without merit.

Serotonin toxicity is real, but you could kill yourself with Tylenol faster than SSRIs.

Originally Posted by johnnydrama

Serotonin toxicity is real, but you could kill yourself with Tylenol faster than SSRIs.

You think so? maybe... you could argue that you could kill others faster with SSRIs than with Tylenol
I dont see NSAID and tylenol arguments as valid here. Yes, the absolute #s may be higher, but when compared to how widespread the use is the actual chances drop quite a bit. How many households have the full gambit of OTC anti-inflammatory and fever reducers in their cupboards as compared with those with anti-psychotics/depressants?

I dont really know a ton on these drugs yet. I just think comparing to tylenol or advil is oversimplifying the issue. Aside from a single friday night binge and then a massive tylenol overdose, I am not aware of OTC deaths/harm that were not due to prolonged overuse. If you pop a fist-full of a neurotransmitter reuptake blocker you are in significantly worse spot than a single fistful of ibuprophen.

and again - this is just to say there is a spectrum and a line somewhere on that spectrum. I'm sure there are certain drugs that could easily be OTC and very likely a larger number that fit this category than those that are OTC that should be made Rx. I just do not accept the "monopoly" theory. There are plenty of things doctors do that will keep us employed aside from writing scripts.

Originally Posted by SpecterGT260

You think so? maybe... you could argue that you could kill others faster with SSRIs than with Tylenol
I dont see NSAID and tylenol arguments as valid here. Yes, the absolute #s may be higher, but when compared to how widespread the use is the actual chances drop quite a bit. How many households have the full gambit of OTC anti-inflammatory and fever reducers in their cupboards as compared with those with anti-psychotics/depressants?

I dont really know a ton on these drugs yet. I just think comparing to tylenol or advil is oversimplifying the issue. Aside from a single friday night binge and then a massive tylenol overdose, I am not aware of OTC deaths/harm that were not due to prolonged overuse. If you pop a fist-full of a neurotransmitter reuptake blocker you are in significantly worse spot than a single fistful of ibuprophen.

and again - this is just to say there is a spectrum and a line somewhere on that spectrum. I'm sure there are certain drugs that could easily be OTC and very likely a larger number that fit this category than those that are OTC that should be made Rx. I just do not accept the "monopoly" theory. There are plenty of things doctors do that will keep us employed aside from writing scripts.

Tylenol's actually incredibly hepatotoxic. It's easily lethal in overdose, and a few professors argued against its regular use at all. People regularly overdose on Tylenol without realizing it.

Aspirin is also easily lethal in overdose, but probably safer overall if you don't have a history of bleeding.

I'm actually not sure there are any cases of death by SSRI overdose. You usually need to combine the with something like an MAOi.

I know tylenol is hard on the liver. I'm just saying I have not seen instances of people dying aside from prolonged overuse or coupled with massive alcohol use. Where abouts is the single-dose lethal overdose for tylenol? many people routinely use 800-1k mg without issue. I would just never do this if I had been drinking or was on any other drug that is oxidized in the liver.

we are getting bogged down. The issue I am trying to discus: is tylenol toxicity an appropriate rationale for making SSRIs OTC? It sounds like a better argument for making tylenol Rx-only.

This is about where do we draw the line in terms of what is Rx and what is OTC. For 1 drug to have a given negative effect and to be found on the OTC side of the line is ONLY an argument for pushing the line back IF we accept that this drug's position is appropriate.

This is why I keep saying the tylenol argument is not appropriate. It is the med/pharm equivalent for arguing towards jumping off a bridge because all of your friends are doing it.

as you said, you have prof's who argue against its use as a whole - therefore citing it and its position on the otc/rx-harm/benefit scale does not support the argument that we are too restrictive and monopolizing with prescriptions. To simplify and restate your argument: I think physicians are too monopolizing with what drugs are available to the population - as evidence, tylenol, an OTC drug kills lots of people every year.

the cause and effect logic is lacking there....

Originally Posted by SpecterGT260

I know tylenol is hard on the liver. I'm just saying I have not seen instances of people dying aside from prolonged overuse or coupled with massive alcohol use. Where abouts is the single-dose lethal overdose for tylenol? many people routinely use 800-1k mg without issue. I would just never do this if I had been drinking or was on any other drug that is oxidized in the liver.

Not sure of the specifics, and also a bit wary of posting them online (don't want to give anyone a how-to guide). It varies from person to person too obviously, but it's not that difficult to do.

It's a slow and painful death, basically destroys your liver and you die of liver failure.

My overall point is that SSRIs are probably safer than Tylenol unless you're also using MAOis or serotonin analogues at the same time.

Originally Posted by johnnydrama

Not sure of the specifics, and also a bit wary of posting them online (don't want to give anyone a how-to guide). It varies from person to person too obviously, but it's not that difficult to do.

It's a slow and painful death, basically destroys your liver and you die of liver failure.

I re-outlined what I am trying to address in the post above this. I think we are going down the wrong rabbit hole here. I am not arguing about whether or not tylenol can be dangerous. i am arguing about whether or not this stands as sounds logic to support the idea that doctors are too restrictive with Rx's

Originally Posted by SpecterGT260

we are getting bogged down. The issue I am trying to discus: is tylenol toxicity an appropriate rationale for making SSRIs OTC? It sounds like a better argument for making tylenol Rx-only.

This is about where do we draw the line in terms of what is Rx and what is OTC. For 1 drug to have a given negative effect and to be found on the OTC side of the line is ONLY an argument for pushing the line back IF we accept that this drug's position is appropriate.

This is why I keep saying the tylenol argument is not appropriate. It is the med/pharm equivalent for arguing towards jumping off a bridge because all of your friends are doing it.

as you said, you have prof's who argue against its use as a whole - therefore citing it and its position on the otc/rx-harm/benefit scale does not support the argument that we are too restrictive and monopolizing with prescriptions. To simplify and restate your argument: I think physicians are too monopolizing with what drugs are available to the population - as evidence, tylenol, an OTC drug kills lots of people every year.

the cause and effect logic is lacking there....

I think it's also relevant to consider the relative risk of taking a medication (such as tylenol or SSRIs, in this discussion), as compared to other risky things that we let any slack-jawed yokel do. Like drive a ton of metal 45 miles an hour through a neighborhood that kids play in, spray pesticides on their lawn, purchase handguns, climb up a ladder to clean out the gutters on their house, drink shots of whiskey until they pass out, operate power tools, hook up with some skank they just met at the bar, use one of those turkey deep-fryer things in their garage, etc, etc. As a society we're fine with letting people take certain risks, but not others. Is there any logic to this, or are we just being erratic and capricious?

Originally Posted by SpecterGT260

I re-outlined what I am trying to address in the post above this. I think we are going down the wrong rabbit hole here. I am not arguing about whether or not tylenol can be dangerous. i am arguing about whether or not this stands as sounds logic to support the idea that doctors are too restrictive with Rx's

I think my point is that consumers have a right to be reckless.

As long as we give them appropriate guidelines, we can't really demand they see us for access to many types of drugs. (I'd make exceptions for things like antibiotics and anything controlled by the DEA.)

Many people still would, mainly because insurance doesn't cover OTCs.

Originally Posted by phltz

I think it's also relevant to consider the relative risk of taking a medication (such as tylenol or SSRIs, in this discussion), as compared to other risky things that we let any slack-jawed yokel do. Like drive a ton of metal 45 miles an hour through a neighborhood that kids play in, spray pesticides on their lawn, purchase handguns, climb up a ladder to clean out the gutters on their house, drink shots of whiskey until they pass out, operate power tools, hook up with some skank they just met at the bar, use one of those turkey deep-fryer things in their garage, etc, etc. As a society we're fine with letting people take certain risks, but not others. Is there any logic to this, or are we just being erratic and capricious?

I agree, and I do not have an answer to that question. The risks you cite do not stand as a direct pro or con argument for either side. The existence of acceptable and non-acceptable risks could just as easily be used to support further restrictions as they could be used to diminish restrictions.

Originally Posted by johnnydrama

I think my point is that consumers have a right to be reckless.

As long as we give them appropriate guidelines, we can't really demand they see us for access to many types of drugs. (I'd make exceptions for things like antibiotics and anything controlled by the DEA.)

Many people still would, mainly because insurance doesn't cover OTCs.

Ok at least now we have a context to the arguments. If that is your opinion then yes, the tylenol argument becomes coherent within that context. But why do you draw the line at antibiotics and DEA drugs (Im assuming narcotics here?). Why doesnt the consumer have equal right to be reckless with those? I do not think you can argue that antibiotics are more dangerous than tylenol - especially when many of them are coming in single-dose or pre-packaged forms now (z-pack, for example). Is the off chance of killing off natural gut bugs or the more obscure generation of a "superbug" worse than the risk of tanking your liver with an acetaminophen and gin cocktail?

There is no evidence of a physician shortage, but it's been said enough times that the parrots are repeating it too.

Originally Posted by SpecterGT260

I agree, and I do not have an answer to that question. The risks you cite do not stand as a direct pro or con argument for either side. The existence of acceptable and non-acceptable risks could just as easily be used to support further restrictions as they could be used to diminish restrictions.


Ok at least now we have a context to the arguments. If that is your opinion then yes, the tylenol argument becomes coherent within that context. But why do you draw the line at antibiotics and DEA drugs (Im assuming narcotics here?). Why doesnt the consumer have equal right to be reckless with those? I do not think you can argue that antibiotics are more dangerous than tylenol - especially when many of them are coming in single-dose or pre-packaged forms now (z-pack, for example). Is the off chance of killing off natural gut bugs or the more obscure generation of a "superbug" worse than the risk of tanking your liver with an acetaminophen and gin cocktail?

I'm guessing you don't consider chloramphenicol an antibiotic?

The reason I make an exception for antibiotics is due to the effect overuse of antibiotics has on society. If we want antibiotics to remain effective, they need to be used judiciously. Farmers are a bigger problem than OTC consumption would be, but I'm against farmers using human compatible antibiotics too.

Narcotics probably could be made legal, but with the same restrictions as tobacco and alcohol.

Originally Posted by DrSnips

I'm guessing you don't consider chloramphenicol an antibiotic?

im going to be very sad very soon if I am lead to believe that the current population of medical students really cannot understand that nitpicking exceptions does not invalidate the points made. There is not a single argument made in SDN that doesnt have an exception that can be found (now hurry, go find an exception to that ).

Rather than hair splitting, why not try addressing the actual topic: in your post quoted above, are you suggesting that tylenol regulation is too lax, that antibiotic regulation is too strict, or.... what exactly? your comment doesn't really accomplish anything.

Originally Posted by johnnydrama

The reason I make an exception for antibiotics is due to the effect overuse of antibiotics has on society. If we want antibiotics to remain effective, they need to be used judiciously. Farmers are a bigger problem than OTC consumption would be, but I'm against farmers using human compatible antibiotics too.

Narcotics probably could be made legal, but with the same restrictions as tobacco and alcohol.

That is reasonable given a specific political position. I just think it is still heavily subjective - and as such doesnt really support a plan to unrestrict medications as a logical outcome. It is more of a result of political values.

Originally Posted by SpecterGT260

That is reasonable given a specific political position. I just think it is still heavily subjective - and as such doesnt really support a plan to unrestrict medications as a logical outcome. It is more of a result of political values.

Basically, I don't think we should really be able to restrict people from things that harm the individual, but things that can harm the community should be restricted (eg antibiotic overuse, and to some extent tobacco/alcohol/narcotics/etc).

I understand we disagree here, but as long as you understand my position I can stop arguing it.

Originally Posted by johnnydrama

Basically, I don't think we should really be able to restrict people from things that harm the individual, but things that can harm the community should be restricted (eg antibiotic overuse, and to some extent tobacco/alcohol/narcotics/etc).

I understand we disagree here, but as long as you understand my position I can stop arguing it.

I actually do not disagree with you on a political basis. Id be fine if we legalized all manner of things. But public health rationale is not always in tune with my political standpoints. I do not see a side where making med restrictions more lax benefits public health in this country because over/misuse is much more likely than denial/hindrance as was discussed for people in africa.

Originally Posted by SpecterGT260

I actually do not disagree with you on a political basis. Id be fine if we legalized all manner of things. But public health rationale is not always in tune with my political standpoints. I do not see a side where making med restrictions more lax benefits public health in this country because over/misuse is much more likely than denial/hindrance as was discussed for people in africa.

Eh, from a public health standpoint we should make alcohol, tobacco, and Whoppers require prescriptions.

Originally Posted by johnnydrama

Eh, from a public health standpoint we should make alcohol, tobacco, and Whoppers require prescriptions.

that is true lol. All of this was just in response to marcus brody who seems to think that the only reason for restricting prescriptions is job security and some vague concept of "the man keepin u down". There has to be so much freedom and public health and as a result some things are allowed and some are not. That is all

Originally Posted by Dr Love

There is no evidence of a physician shortage, but it's been said enough times that the parrots are repeating it too.

When physicians in every field have a 100% employment rate that's evidence of a physician shortage in every field. If you're selling a product, and people buy every single one that you're selling, its usually a good bet that demand outstrips supply.

Originally Posted by Perrotfish

When physicians in every field have a 100% employment rate that's evidence of a physician shortage in every field. If you're selling a product, and people buy every single one that you're selling, its usually a good bet that demand outstrips supply.

That's not really how supply and demand works.

Excess supply decreases the natural price of the good. Efficiency in the market is what decides how much of the product is sold.

In a 100% efficient market, all products should be sold, albeit some at markedly reduced prices.

NRMP data would suggest that employment is not 100% among people with physician degrees.

Originally Posted by johnnydrama

That's not really how supply and demand works.

Excess supply decreases the natural price of the good. Efficiency in the market is what decides how much of the product is sold.

In a 100% efficient market, all products should be sold, albeit some at markedly reduced prices.

True enough, I'm aware its an oversimplification. Any time the government is directly manipulating the market on both the supply (licensing) and demand (free government insurance) side of the equation its not going to be a true free market anyway. The fact is, though, that there are people who want to see basically every kind of physician that can't, or need to wait months to do so, and are not actually priced out of the market. There are more people who want to buy than there are people willing to sell.

NRMP data would suggest that employment is not 100% among people with physician degrees.

Degrees or licenses?

Originally Posted by Perrotfish

True enough, I'm aware its an oversimplification. Any time the government is directly manipulating the market on both the supply (licensing) and demand (free government insurance) side of the equation its not going to be a true free market anyway. The fact is, though, that there are people who want to see basically every kind of physician that can't, or need to wait months to do so, and are not actually priced out of the market. There are more people who want to buy than there are people willing to sell.

It's a distribution issue. That's why doctors earn more in the Midwest and South than the Northeast (supply/demand).

There's also the whole specialist issue, which has more to do with artificial pricing as you mention. Although, I don't think the public actually values primary care as much as it claims to, otherwise there would be higher salaries available to PCPs.

Originally Posted by Perrotfish

Degrees or licenses?

does it matter? Why does a well matched residency/job market reflect a physician shortage? There are tons of people who want to be physicians who are denied which indicates saturation. The existence of a bottle-neck does not prove or disprove a shortage and that is all residency is: a quality control checkpoint.

Originally Posted by Perrotfish

When physicians in every field have a 100% employment rate that's evidence of a physician shortage in every field. If you're selling a product, and people buy every single one that you're selling, its usually a good bet that demand outstrips supply.

Except that 1. "people" aren't buying healthcare, the cost is covered by insurance or government programs. 2. Doctors can create their own demand.

If a doctor tells you that you need a certain test, and you are not paying for it, of course you will go along with it. Various studies say that something like 30-40% of all healthcare costs are for procedures and tests with no medical benefit. If you increase the physician supply, the number will only go up.

Originally Posted by johnnydrama

It's a distribution issue. That's why doctors earn more in the Midwest and South than the Northeast (supply/demand).

Doctors are still at 0% unemployment and making well over 100K for even FP jobs in the northeast. They're less under supplied, but they still are under supplied.

There's also the whole specialist issue, which has more to do with artificial pricing as you mention. Although, I don't think the public actually values primary care as much as it claims to, otherwise there would be higher salaries available to PCPs.

I remember McDonalds briefly experimented with healthy menu items: salads, low cal drinks, etc. On survey after survey their consumers were demanding healthier options. They all flopped. After than they learned to base their new products entirely on taste tests and intensive focus groups in settings where people actually had to eat the food they kept saying they wanted. It turns out that people's stated desires are not actually a good reflection of their actual desires.

does it matter? Why does a well matched residency/job market reflect a physician shortage? There are tons of people who want to be physicians who are denied which indicates saturation. The existence of a bottle-neck does not prove or disprove a shortage and that is all residency is: a quality control checkpoint.

The fact that people who want to be physicians are denied the opportunity doesn't indicate saturation, it indicates protectionism. We have created a quality control checkpoint with an unreasonably high minimum standard, despite the fact that there is no evidence that less educated care providers harm the community, because it keeps the demand lower than the supply and therefore keeps our salaries artificially high.

My point about degrees vs. licenses is that the bottle neck is at licensure. We have a lot of physicians who get degrees but can't get into/through an internship, so it makes sense they're unemployed. It certainly seems like anyone who makes it through an intern year, though, can find gainful employment somewhere. Heck, my state's prison system alone could take tons of them.

Originally Posted by Dr Love

Except that 1. "people" aren't buying healthcare, the cost is covered by insurance or government programs. 2. Doctors can create their own demand.

If a doctor tells you that you need a certain test, and you are not paying for it, of course you will go along with it. Various studies say that something like 30-40% of all healthcare costs are for procedures and tests with no medical benefit. If you increase the physician supply, the number will only go up.

#2 has been shown to be true numerous times. One of the concerns with increasing residency spots is that most of the the extra residents will flock to the same places the majority of their colleagues are going already - the east and west coasts, followed by (the periphery of) larger cities throughout the rest of the country, leaving us with the same rural and inner city shortage of primary care docs that we have now.

Edit: Plus healthcare expenses in the areas that were already oversaturated with physicians will rise (as has been shown to happen) as physicians literally create their own demand via referrals and extra services.

Originally Posted by Dr Love

Except that 1. "people" aren't buying healthcare, the cost is covered by insurance or government programs. 2. Doctors can create their own demand.

If a doctor tells you that you need a certain test, and you are not paying for it, of course you will go along with it. Various studies say that something like 30-40% of all healthcare costs are for procedures and tests with no medical benefit. If you increase the physician supply, the number will only go up.

I disagree with the notion that people automatically agree with us, or that we can infinitely 'create demand'. Our patients are barely compliant as it is. I do concede that compliance would be drastically lower, and most of the most expensive/meaningless tests would disappear entirely, if the government stopped footing the bill. However patients still do need to buy into their medical care or they won't buy it even if they're paying nothing. The fact is they want what we're selling. And there's not a over supply of something that's selling as well as medical care sells in the United States right now.

The idea that a profession could 'create its own demand' used to be something people said about Law. After all, law suits were easy to start, and it was easy to continuously raise the standard for the legal boilerplate needed by businesses, so the market could basically tolerate an infinite number of lawyers right? Well then they hit the saturation point, and then went way over it, and now legions of Lawyers are finding out that they're a product like anything else, except that rather than being under supplied they are now over supplied. Which is indicated by their massive levels of unemployment.

Originally Posted by Perrotfish

I disagree with the notion that people automatically agree with us, or that we can infinitely 'create demand'. Our patients are barely compliant as it is. I do concede that compliance would be drastically lower, and most of the most expensive/meaningless tests would disappear entirely, if the government stopped footing the bill. However patients still do need to buy into their medical care or they won't buy it even if they're paying nothing. The fact is they want what we're selling. And there's not a over supply of something that's selling as well as medical care sells in the United States right now.

The idea that a profession could 'create its own demand' used to be something people said about Law. After all, law suits were easy to start, and it was easy to continuously raise the standard for the legal boilerplate needed by businesses, so the market could basically tolerate an infinite number of lawyers right? Well then they hit the saturation point, and then went way over it, and now legions of Lawyers are finding out that they're a product like anything else, except that rather than being under supplied they are now over supplied. Which is indicated by their massive levels of unemployment.

You're right in general, but you are twisting words. Nobody said physicians could create infinite demand. They can certainly create demand, and you can look up the numerous studies that have shown this on your own, but they cannot create infinite demand. There is a saturation point, and it is possible to create too many physicians to the point that we end up exactly where the legal profession is. We're nowhere near that point, but I concede that it is possible.

Originally Posted by SteinUmStein

You're right in general, but you are twisting words. Nobody said physicians could create infinite demand. They can certainly create demand, and you can look up the numerous studies that have shown this on your own, but they cannot create infinite demand. There is a saturation point, and it is possible to create too many physicians to the point that we end up exactly where the legal profession is. We're nowhere near that point, but I concede that it is possible.

We could easily create infinite demand, if only the pesky DEA would get off our backs...

Originally Posted by Perrotfish

I disagree with the notion that people automatically agree with us, or that we can infinitely 'create demand'. Our patients are barely compliant as it is. I do concede that compliance would be drastically lower, and most of the most expensive/meaningless tests would disappear entirely, if the government stopped footing the bill. However patients still do need to buy into their medical care or they won't buy it even if they're paying nothing. The fact is they want what we're selling. And there's not a over supply of something that's selling as well as medical care sells in the United States right now.

The idea that a profession could 'create its own demand' used to be something people said about Law. After all, law suits were easy to start, and it was easy to continuously raise the standard for the legal boilerplate needed by businesses, so the market could basically tolerate an infinite number of lawyers right? Well then they hit the saturation point, and then went way over it, and now legions of Lawyers are finding out that they're a product like anything else, except that rather than being under supplied they are now over supplied. Which is indicated by their massive levels of unemployment.

Of course you cannot infinitely create demand. There is a limit. So far we have not reached the limit and what we find is that areas with lots of doctors, regardless of the demographics of the population, have increased medical costs per capita. But as insurance premiums and government expenditures continually increase, eventually the public will demand that something real be done about it. In Europe, that has meant doctors get paid about the same as our residents do in America.

I think we need to think about what the agenda of those talking about a physician shortage is. I don't mean the powerless students who simply parrot what they hear, but real lobbies advocating for actual policy changes that will harm the medical profession. These include opening new medical schools, opening up more residency slots, or giving non-physicians authority generally reserved for physicians.

Originally Posted by Perrotfish

The fact that people who want to be physicians are denied the opportunity doesn't indicate saturation, it indicates protectionism. We have created a quality control checkpoint with an unreasonably high minimum standard, despite the fact that there is no evidence that less educated care providers harm the community, because it keeps the demand lower than the supply and therefore keeps our salaries artificially high.

My point about degrees vs. licenses is that the bottle neck is at licensure. We have a lot of physicians who get degrees but can't get into/through an internship, so it makes sense they're unemployed. It certainly seems like anyone who makes it through an intern year, though, can find gainful employment somewhere. Heck, my state's prison system alone could take tons of them.

you have to defend this claim. you cannot say that it is unreasonably high. And the lack of evidence that mid-levelers harm the population is a result of mid-level autonomy being very new. It is also a result of inappropriate tests being done to assess the outcome. The last study I saw had less than 50% of NPs being able to pass USMLE step 3. Are you suggesting that this test is not correlated to medical competence and, by extension, that medical competence is not correlated to patient outcomes?

You are assuming that 0% unemployment cannot be a result inherent to the system. Your argument assumes that if we were to expand physician numbers that we will inevitably have to have an increase in unemployment. Prostitution also has an unemployment rate of 0%. Are we in the middle of a hooker shortage as well? I'm just saying that your "supply and demand" model is too simplistic here and 0% unemployment can be accomplished through artificial means.

Well,
I don't know aboout a shortage, but I got a clinical job working a 4 day week for 200+K in 4 hrs of looking. I am a researcher by trade, but have gone into clinical work becasue I actually enjoy taking care of people, and I have horses to feed!

Internists can expect anywhere between 120K on the very low end to 250K to start.

But as I told my med students if you really want the big bucks , go to law school and sue Drs!

Originally Posted by johnnydrama

That's not really how supply and demand works.

Excess supply decreases the natural price of the good. Efficiency in the market is what decides how much of the product is sold.

In a 100% efficient market, all products should be sold, albeit some at markedly reduced prices.

What is the difference in % of products sold in a 100% efficiency market versus an inefficient market where demand outstrips supply?

Using only one criteria you cannot disprove his statement, either