doctor shortage - nyt

[Jack is Back]

What u think?

http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html? _r=2&ref=todayspaper

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[WallStat]

Pretty soon politicians and MPHs will question the expenditure of public funds to encourage the production of plastic surgeons and derms and dubious make-work "medical research" at state academic centers while there is such a dire need in primary care and grandmas/grandmas/Medicare/Medicaid folks have zero access except the ER.

I expect the deans of these new "primary care focus" schools like UCR will be interrogated if too few of their new MDs match primary care.

 

[neusu]

I beg to differ with the dean, there indeed are shortages in both plastic surgery and dermatology.

The article touches on that we as a country, as we age, consume more healthcare yet don't seek preventative care. What it does not touch on is that our perspective is that for the most part, we do not accept death as an option and can not let go.

 

[circulus vitios]

But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.

This says it all. Educated professionals don't want to live in hick dumps or ghetto hellholes.

 

[notbobtrustme]

Incentives matter and the incentives to go into primary care have been dwindling for 20+ years now.

The cap on resident funding is also coming back to bite us in the ass. It's perfect short-term thinking. Balance the budget today, screw the consequences.

Finally, this article highlights the folly of medical school debt in general. That is the big elephant in the room. We give up 7-10 years of lost earnings and go into massive debt, it's no wonder we choose specialties that are high paying rather than primary care. Instead of buying 50 new F-22s, we could buy 40, fund everyone's medical education, expand resident training spots, and provide incentives to go into primary care. But that makes too much sense.

 

[sibitrum]

Incentives matter and the incentives to go into primary care have been dwindling for 20+ years now.

The cap on resident funding is also coming back to bite us in the ass. It's perfect short-term thinking. Balance the budget today, screw the consequences.

Finally, this article highlights the folly of medical school debt in general. That is the big elephant in the room. We give up 7-10 years of lost earnings and go into massive debt, it's no wonder we choose specialties that are high paying rather than primary care. Instead of buying 50 new F-22s, we could buy 40, fund everyone's medical education, expand resident training spots, and provide incentives to go into primary care. But that makes too much sense.

I definitely agree that government priorities are not aligned as they should be, especially regarding military adventurism. I'm not as sure, though, that the problem with getting more primary care docs is med school debt. I think people would still generally prefer higher paying jobs over lower paying ones, even at low debt levels. Instead, I think primary care docs should make a bit more and specialists a bit less.

In addition, the number of residency slots is more of a limiting factor than US allopathic md slots. While not ideal, those trained overseas can always be used to fill residency positions. That said, from a international medical perspective, you end up draining med students from other countries.

 

[FunnyCurrent]

I definitely agree that government priorities are not aligned as they should be, especially regarding military adventurism. I'm not as sure, though, that the problem with getting more primary care docs is med school debt. I think people would still generally prefer higher paying jobs over lower paying ones, even at low debt levels. Instead, I think primary care docs should make a bit more and specialists a bit less.

In addition, the number of residency slots is more of a limiting factor than US allopathic md slots. While not ideal, those trained overseas can always be used to fill residency positions. That said, from a international medical perspective, you end up draining med students from other countries.

How about primary care docs make a lot more than presently possibly with reimbursement as it is now and specialists make the same amount as present keeping up with inflation. Also, how about insurance companies make less.

 

[sibitrum]

How about primary care docs make a lot more than presently possibly with US reimbursement and specialists make the same amount as present keeping up with inflation. Also, how about insurance companies make less.

That would be nice, but I think it would be politically untenable for the average salary of physicians to go up.

 

[dsoz]

For me, it all comes down to debt. If I could get out of med school with less debt, then I would consider primary care more than I am. I don't know if it is financially feasible for me to go into PC.

I am a second career person. Right now I make roughly $10k more than the average resident. I will have to quit my job, take on about $250k in debt (about the cost of a newer house in the area I live), then make 120k to 150k per year (about double what I am making now) doing primary care. I don't think I will even break even. That does not even take into consideration putting away for retirement (right now my job is putting about 18% of my meager salary into a state retirement system).

I am not saying that I won't do it, but it would be one of my last options. Finances are not the reason that I am changing careers, but it is one factor in choosing what to do with medicine when I am done.

Now if there were special medical schools that cost less that were operating to ONLY train PC docs, I would consider it. But then again, wouldn't that be just a glorified PA or DNP?

dsoz

 

[FunnyCurrent]

That would be nice, but I think it would be politically untenable for the average salary of physicians to go up.

As long as doctors are ***** ass bitches you're right.

I have never met such an overtly feminized group of men as during orientation first year. Might as well have been neutered. Where's your balls people where's your effin ballz?

 

[FSU2013]

This says it all. Educated professionals don't want to live in hick dumps or ghetto hellholes.

I dunno, I'm from what quite a few people would consider a redneck town and I love it. It's my home, where I grew up, where I'd like to raise kids.

My wife is from somewhere that is the epitome of a redneck town. But there is something to be said for being able to leave your doors unlocked, knowing your neighbors, being able to live on a lake, only driving 10 minutes to go shooting, having enough property to shoot a bow and arrow in your front lawn.....

I think a lot of people from places like NYC, Boston, LA, San Francisco, etc think that there isn't life outside of those places. Sure, those places are great, but there's life outside of that.

 

[Frazier]

As long as doctors are ***** ass bitches you're right.

I have never met such an overtly feminized group of men as during orientation first year. Might as well have been neutered. Where's your balls people where's your effin ballz?

 

[Kaputt]

I dunno, I'm from what quite a few people would consider a redneck town and I love it. It's my home, where I grew up, where I'd like to raise kids.

My wife is from somewhere that is the epitome of a redneck town. But there is something to be said for being able to leave your doors unlocked, knowing your neighbors, being able to live on a lake, only driving 10 minutes to go shooting, having enough property to shoot a bow and arrow in your front lawn.....

I think a lot of people from places like NYC, Boston, LA, San Francisco, etc think that there isn't life outside of those places. Sure, those places are great, but there's life outside of that.

These small-town places really only seem great to the people that grew up in them. I can see myself returning to an area similar to where I grew up (near a decently-sized midwestern city), but I can't possibly see myself going to a place like you describe, nor do I expect anyone else to go to my hometown to practice.

What we need are more people from those under-served areas getting medical degrees and going back. You can't expect someone who grew up in and trained in a large city to go to some "podunk" town and enjoy it.

 

[Shnurek]

These small-town places really only seem great to the people that grew up in them. I can see myself returning to an area similar to where I grew up (near a decently-sized midwestern city), but I can't possibly see myself going to a place like you describe, nor do I expect anyone else to go to my hometown to practice.

What we need are more people from those under-served areas getting medical degrees and going back. You can't expect someone who grew up in and trained in a large city to go to some "podunk" town and enjoy it.

Bullcrap. I'd love to live in a place like that and I've lived in this NYC craphole my entire life. I hate LA, I hate Miami, I hate all those over-populated, polluted and stuck up places.

 

[kpcrew]

These small-town places really only seem great to the people that grew up in them. I can see myself returning to an area similar to where I grew up (near a decently-sized midwestern city), but I can't possibly see myself going to a place like you describe, nor do I expect anyone else to go to my hometown to practice.

What we need are more people from those under-served areas getting medical degrees and going back. You can't expect someone who grew up in and trained in a large city to go to some "podunk" town and enjoy it.

Or maybe they're tired of their surroundings and want a change. It could be that people getting medical degrees from underserved areas are trying to better their situation and escape from poverty. I doubt that people live in poor areas by choice.

 

[pseudosquam]

Indeed. I have learned this to be true of the African American culture by watching various popular culture movies. It would seem that once they've "escaped" the ghetto they do not want to go back. Some of those left behind resent this and believe said professional have forgotten their roots and "sold out".

For an non-AA example listen to a song called "Jenny From The Block" by J-Lo where she goes to great lengths to assure that she is still apart of her poor beginnings despite her success and non-ghetto street address. According to her we must not be "fooled by the rocks that [she] got".

Or maybe they're tired of their surroundings and want a change. It could be that people getting medical degrees from underserved areas are trying to better their situation and escape from poverty. I doubt that people live in poor areas by choice.

 

[Kaputt]

Bullcrap. I'd love to live in a place like that and I've lived in this NYC craphole my entire life. I hate LA, I hate Miami, I hate all those over-populated, polluted and stuck up places.

You're still trolling Allo?

Or maybe they're tired of their surroundings and want a change. It could be that people getting medical degrees from underserved areas are trying to better their situation and escape from poverty. I doubt that people live in poor areas by choice.

Quite possible. But if people that come from underserved, impoverished areas don't end up going back to serve them, how could you expect anyone else that has no connection to the area whatsoever to go serve there?

 

[kpcrew]

Quite possible. But if people that come from underserved, impoverished areas don't end up going back to serve them, how could you expect anyone else that has no connection to the area whatsoever to go serve there?

It's a fine point and I don't have a good answer for that. You could try mandating aways in those areas so that students can experience them or give some kind of financial incentive for working there but it seems that any solution you can imagine come with their own issues.

 

[eject]

It'll be interesting to see how this plays out--especially on the compensation side. On a related note, I was somewhat surprised to see that there is a growing belief on the right that we pay medical professionals (including physicians) too much. A recent example:


The Great Unmentionable
The role of high salaries and wages in health care inflation:

Absent a reform that simply ends government involvement in health care altogether, it’s hard to envisage lower health care costs without lower compensation for workers in the sector.

I think it raises the specter of a political consensus on right and left that we spend too much on compensation--and that fixing that perceived problem (through scope of practice changes, reimbursements, etc) would solve all that ails the healthcare system.

 

[bomgd3]

It'll be interesting to see how this plays out--especially on the compensation side. On a related note, I was somewhat surprised to see that there is a growing belief on the right that we pay medical professionals (including physicians) too much. A recent example:


The Great Unmentionable
The role of high salaries and wages in health care inflation:




I think it raises the specter of a political consensus on right and left that we spend too much on compensation--and that fixing that perceived problem (through scope of practice changes, reimbursements, etc) would solve all that ails the healthcare system.

Arrrrgh. That article raises my blood pressure so much! What a total idiot, trying to talk about a job he knows nothing about. Doctor's salaries are a tiny proportion of overall healthcare costs, and we take on massive responsibility and sacrifice. I almost stopped reading when he tried to argue that doctors are overpaid because we generally make more than lawyers, but only "spend one year more in school".

 

[michaelrack]

[x

 

[circulus vitios]

Bullcrap. I'd love to live in a place like that and I've lived in this NYC craphole my entire life. I hate LA, I hate Miami, I hate all those over-populated, polluted and stuck up places.

I've lived in a town of 3000 people all of my life. Having literally nothing to do gets old. Word of advice: start saving for private school because you don't want to condemn your child to a poorly-funded and bottom-ranking rural, public school. (Before you ask, I went to such a school.)

 

[Smokemont]

I've lived in a town of 3000 people all of my life. Having literally nothing to do gets old. Word of advice: start saving for private school because you don't want to condemn your child to a poorly-funded and bottom-ranking rural, public school. (Before you ask, I went to such a school.)

Having to live in overpopulated major cities filled with *****holes also gets old. Some people prefer more rural area.

 

[WellWornLad]

I've lived in a town of 3000 people all of my life. Having literally nothing to do gets old. Word of advice: start saving for private school because you don't want to condemn your child to a poorly-funded and bottom-ranking rural, public school. (Before you ask, I went to such a school.)

This and the preceding quote about NYC illustrate nicely that young people, no matter where they grow up, want to leave as soon as possible.

 

[Shnurek]

Having to live in overpopulated major cities filled with *****holes also gets old. Some people prefer more rural area.

Exactly

This and the preceding quote about NYC illustrate nicely that young people, no matter where they grow up, want to leave as soon as possible.

The grass is always greener on the other side mentality. Is there a psychiatric term for this?

 

[Jack is Back]

Indeed. I have learned this to be true of the African American culture by watching various popular culture movies. It would seem that once they've "escaped" the ghetto they do not want to go back. Some of those left behind resent this and believe said professional have forgotten their roots and "sold out".

For an non-AA example listen to a song called "Jenny From The Block" by J-Lo where she goes to great lengths to assure that she is still apart of her poor beginnings despite her success and non-ghetto street address. According to her we must not be "fooled by the rocks that [she] got".

Epic post.

I lol'ed

 

[Badger MD]

Having to live in overpopulated major cities filled with *****holes also gets old. Some people prefer more rural area.

How rural are you talking? I'm from the Milwaukee area and whenever I drive around northern Wisconsin, I see countless towns that only boast a McDonald's, a gas station, and maybe a K-Mart. We always wonder where people work in towns like that, and we can only assume it's factories in neighboring towns. Why would any educated professional want to live in a setting like that? Not only does it lack incentive for the physicians themselves, but not to mention a complete lack of opportunity for their spouse/children (both from an educational perspective and an employment one).

I could see why living in a larger city like New York or Boston could get annoying, but I feel like the positives far outweigh the negatives. Sure, you get more friendly and simple people in a rural setting, but not much else.

 

[Shnurek]

Well it depends if you like doing nature stuff. If you want your kids to grow up in the city where they never get stung by bees or never get exposed to enough other natural pathogens so they develop allergies later in their adolescence then so be it. Urban living is a risk factor for mental disease too. There's a lot of formal research on the pros and cons of urban living. But for me, I enjoy hiking, camping and skiing so I have no problem living in a less over-populated setting.

 

[KnuxNole]

Rural life sounds kinda boring

Aren't people friendly in big cities too? It seems like with the immense population, especially of younger people, people are eager to meet others and there are lots of places to find like-minded people. In a rural city, it feels like there might not be a lot of diversity of people and/or interests.

 

[Shnurek]

Rural life sounds kinda boring

Aren't people friendly in big cities too? It seems like with the immense population, especially of younger people, people are eager to meet others and there are lots of places to find like-minded people. In a rural city, it feels like there might not be a lot of diversity of people and/or interests.

Maybe that's why people get along so well in rural settings? I'd love to live in a town where I don't have to lock my doors and there are no hood rats yelling in the street at night.

 

[KnuxNole]

Diversity doesn't mean hood rats -_____-
I'm guessing you are living in the bad part of NYC...

I would hate to be in a place where people only have one religion, are uber conservative, and have nothing fun to do except play with horses on a farm or going on a long mountain ride. Those are fun for vacation stuff though.

 

[Shnurek]

To each their own

 

[Ischiowhat]

Obviously whenever you restrict entry to a field there will be less supply and more unmet demand, the result being shortages and higher prices. This is micro 101 people, don't act like it's any surprise.

 

[Bacchus]

The big city is for your 20s. I can't wait to start residency outside of the actual city. Thank god. I'm so over it.

 

[KnuxNole]

The big city is for your 20s. I can't wait to start residency outside of the actual city. Thank god. I'm so over it.

and 30s too!

 

[Bacchus]

and 30s too!

No. Well for me at least. The closest to a city I see myself going is the suburbs. Commuting in for work? Probably not.

I want a yard for my dog and children to play in. I want trees. I want to know my neighbors. You get the picture.

 

[newfeet]

And 40s and 50s and 60s

 

[Rubiconcrossing]

I grew up in a small town (pop <800) and from the comments, I am guessing that you have had to live in a small town in order to understand why you would want to stay there.

 

[Shnurek]

I grew up in a small town (pop <800) and from the comments, I am guessing that you have had to live in a small town in order to understand why you would want to stay there.

I can name 20 ways that small towns are better than big cities. All there really is to do in NYC for example is to go drinking or eat at restaurants which drains your wallet FAST. $7 for a beer here at an average Manhattan bar.

 

[cbrons]

Bullcrap. I'd love to live in a place like that and I've lived in this NYC craphole my entire life. I hate LA, I hate Miami, I hate all those over-populated, polluted and stuck up places.

I would have to say I absolutely agree with your sentiments. I grew up in a major metropolitan area and I absolutely hate it. I went to undergrad and graduate school in a rural area, and felt much more at home. I do not understand why people want to live in a big city like Chicago. The crime is bad, the taxes are through the roof, the politicians are corrupt as you get, the people are mostly stuck up and uncaring, there's bums everywhere - usually encouraged to proliferate thanks to the bleeding heart *****s who usually run big cities, the rats are the sizes of small house cats, etc. I could not wait to get out the big city I grew up in.

 

[cbrons]

I can name 20 ways that small towns are better than big cities. All there really is to do in NYC for example is to go drinking or eat at restaurants which drains your wallet FAST. $7 for a beer here at an average Manhattan bar.

People think big cities are so great because "there is so much to do." Usually when you ask them what there is to do they list things that they never end up doing anyway (opera, art museams, etc.) I couldn't care less about any of that anyway.

At least in a small town you actually feel like someone who is making a difference in the community. People know you, you know them (for the most part), and its just a much better setup IMO.

 

[NickNaylor]

How rural are you talking? I'm from the Milwaukee area and whenever I drive around northern Wisconsin, I see countless towns that only boast a McDonald's, a gas station, and maybe a K-Mart. We always wonder where people work in towns like that, and we can only assume it's factories in neighboring towns. Why would any educated professional want to live in a setting like that? Not only does it lack incentive for the physicians themselves, but not to mention a complete lack of opportunity for their spouse/children (both from an educational perspective and an employment one).

I could see why living in a larger city like New York or Boston could get annoying, but I feel like the positives far outweigh the negatives. Sure, you get more friendly and simple people in a rural setting, but not much else.

I have a family member that is an executive of a multinational company that lives about an hour north of Milwaukee in Wisconsin. I'll admit that he's a midwesterner through and through, but he absolutely loves the setting. He also has a modest log cabin house with ~50 acres of land - all for less (in fact, just under 50%) than the price of a 1 BR apartment in the new Ritz-Carlton building on Michigan Ave. in Chicago. It's all relative. I could definitely see myself living somewhere like that. Yes, there are sacrifices that you have to make, but then again you also have to make sacrifices to live in a big urban area - most notably the ridiculous COL.

 

[KnuxNole]

There is tons of stuff to do in big cities...same with small towns. It's just WHAT to do is the big difference. I personally don't care for the wilderness/outdoors.

In terms of meeting new people, big cities is a welcoming venue. It is very easy to meet people for friends, dates, etc. Small towns, you see the SAME people all the time, which is extremely horrible. I spent high school in a smaller town and couldn't wait to get to a bigger city. Other than running away to the beaches, it was boring as hell. So, I guess the "nothing to do" goes both ways in big/small cities. Some people find big cities boring, while others find smaller towns boring.

 

[Bacchus]

People think big cities are so great because "there is so much to do." Usually when you ask them what there is to do they list things that they never end up doing anyway (opera, art museams, etc.) I couldn't care less about any of that anyway.

At least in a small town you actually feel like someone who is making a difference in the community. People know you, you know them (for the most part), and its just a much better setup IMO.

Exactly. I've lived in Philadelphia for the past 7 years. I've never visited the Liberty Bell. I've gone to one show in the entire city. I've never gone to a concert down here. I haven't heard the orchestra at the Academy of Music. I haven't gone to Geno's or Pat's (preference, haha). I've never gone to the Constitution Center or had my picture taken with Ben Franklin.

The reality is, there are a lot of things to do. However, finding time to do them is much more difficult. And now, when I have down time, I just want to relax.

 

[Shnurek]

The crime is bad, the taxes are through the roof, the politicians are corrupt as you get, the people are mostly stuck up and uncaring, there's bums everywhere - usually encouraged to proliferate thanks to the bleeding heart *****s who usually run big cities, the rats are the sizes of small house cats, etc. I could not wait to get out the big city I grew up in.

Haha, don't even get me started on the bums. People in cities try to filter them out but they are annoying as hell anyway. When I was younger I thought certain things bums did was funny and I could tolerate them more but now I just find them annoying and want to stay as far away from them as possible. I could tell you a lot of subway bum stories I honestly don't know how ED physicians in big cities keep themselves from blowing their brains out. Dealing with bums that don't pay for any treatment. I'd have lived in a small town about 6 years ago but ironically it is cheaper for me to remain in the city until I finish my degree. Because I have somewhat unique circumstances. Just 2.5 more years until externships arghh!!

 

[Shnurek]

Exactly. I've lived in Philadelphia for the past 7 years. I've never visited the Liberty Bell.

Lol I've never visited the Empire State building. But I was on top of the WTC, that's a memory for a lifetime! I hope they will open up the roof of the freedom tower someday.