"Obamacare could worsen doctor shortage"

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Samiamm

Samiamm

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CNN Anchorwoman sat down with the dean of John Hopkins School of Medicine

Supposedly AAMC is predicting that in 2015, the US will have 62,000 fewer doctors then needed, in 2020, it could be 90,000+, and in 2025, it could be 125,000+.

The Dean of John Hopkins proposed increasing class sizes and the number of accepted applicants, along with increasing the number of medical schools, as a long term solution. IMO, this will make getting into med school much easier, and might make a physician's career similar to that of a lawyer's, where the lawyer's graduating from hot shot universities are the only ones making real money.

Of course, there is no major shortage expected for the fields dermatology and plastic surgery (not a surprise).

Due to the fact that a lot more people have medicare/medicaid now, medicaid reimbursements have fallen for primary care physicians.

I was in Roanoke this weekend and my sister pointed out that V-tech just opened a new medical school in Roanoke. To attract students, they allowed free tuition for the first year.

Where do you guys see the careers of physicians heading with these changes?
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you're asking the wrong crowd...try asking this question in a forum with people who are actually involved in the system
 
I'm not sure increasing class size would make it "much easier" to get in, since many very qualified applicants are not accepted currently due to the number of spots vs applicants
 
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This problem won't be fixed by graduating more medical students. Residency slots will ultimately have to be increased, and that is funded by federal dollars. We could double the size of every med school in the country, but what good would that do when your 30,000 residencies are fixed at that level?
 
Richard Dawkins said:
you're asking the wrong crowd...try asking this question in a forum with people who are actually involved in the system
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There are many well informed premeds on here and physicians also check this section of the forum.
 
Students still won't want to work in inner cities or in the hinterlands, no matter how many additional seats are created in med schools. That's where the need for doctors is.
 
quiltlady said:
Students still won't want to work in inner cities or in the hinterlands, no matter how many additional seats are created in med schools. That's where the need for doctors is.
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They have said they would increase the reimbursements for doctors willing to work in those areas.
 
Samiamm said:
They have said they would increase the reimbursements for doctors willing to work in those areas.
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if you're already making 200k a year, how much more would they have to pay you to live in the middle of nowhere? 10%? 25%? 50%?
 
Richard Dawkins said:
if you're already making 200k a year, how much more would they have to pay you to live in the middle of nowhere? 10%? 25%? 50%?
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Some of those rural areas can be quite lucrative to work in. I've heard of places that will pay your loans, buy you a house, and pay you 2-3x what you'd make in a larger city if you'll work for them for a couple of years.
 
I have no idea, honestly I think I'd be happy making 200k a year, but who knows how one's opinion changes after all those years of education and training. Plus, high salary is a HUGE factor in why I want to become a doctor, not because I'm greedy, but because I want to help my family with debt problems. It would have to be in top 3.
 
armybound said:
Some of those rural areas can be quite lucrative to work in. I've heard of places that will pay your loans, buy you a house, and pay you 2-3x what you'd make in a larger city if you'll work for them for a couple of years.
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That is why rural areas appeal to me.
 
quiltlady said:
Students still won't want to work in inner cities or in the hinterlands, no matter how many additional seats are created in med schools. That's where the need for doctors is.
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i have to agree with this sentiment. most dr's want to go into specialties that are not able to be supported by rural care areas or if they don't go into specialities, they already have the location they want to live picked out. and lets be honest, its probably not going to be rural or inner city.

armybound said:
Some of those rural areas can be quite lucrative to work in. I've heard of places that will pay your loans, buy you a house, and pay you 2-3x what you'd make in a larger city if you'll work for them for a couple of years.
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yes they can be but that doesn't solve the problem. only plugs it momentarily. you may pay for a few years while they are there, but then what do you do when they are going to leave? offer them even more? try to scramble to find new people? either way it continues to cost you even more money. I know this because i've seen it from experience as i have a cousin and her husband that are both ob/gyns that got their loans paid plus a huge salary but are leaving after 4 years.


Samiamm said:
They have said they would increase the reimbursements for doctors willing to work in those areas.
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it just isn't that simple.


Richard Dawkins said:
if you're already making 200k a year, how much more would they have to pay you to live in the middle of nowhere? 10%? 25%? 50%?
Click to expand...

exactly. you end up losing your a** trying to compensate. the issue is people will live where they want to live unless you provide gross sums of money to compensate. and even then they will leave when they've gotten enough money where it doesn't matter anymore.
 
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I think it can be simplified a little. I don't understand why they get all their loans paid off plus a huge salary for only 4 years.
 
armybound said:
Some of those rural areas can be quite lucrative to work in. I've heard of places that will pay your loans, buy you a house, and pay you 2-3x what you'd make in a larger city if you'll work for them for a couple of years.
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Seriously, check out the physician forums here guys. Docs in numerous specialties can make BIG bucks taking rural gigs. At that point, it's not about the money, it's the environment that keeps people away.
 
Samiamm said:
I think it can be simplified a little. I don't understand why they get all their loans paid off plus a huge salary for only 4 years.
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the 4 years thing often comes from that's how long (in my cousin's example) that they have to sign a contract to stay for
 
To me Rural medicine sounds amazing. I love the outdoors, hiking, fishing, scuba diving, biking, etc. Im tired to living where I live. I can't wait!!
 
gettheleadout said:
Seriously, check out the physician forums here guys. Docs in numerous specialties can make BIG bucks taking rural gigs. At that point, it's not about the money, it's the environment that keeps people away.
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Exactly. Highly educated people want the same for their children, which they are unlikely to find in rural America. People like to live around others of their same religion, ethnicity, whatever, and even a high salary doesn't buy that.
 
What makes you think that a non-white doctor would be welcome in rural America? They couldn't pay me enough to go there if I was afraid of getting shanked on the way to work.
 
HughMyron said:
What makes you think that a non-white doctor would be welcome in rural America? They couldn't pay me enough to go there if I was afraid of getting shanked on the way to work.
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That would be bad. Who's gonna fix you up?
 
quiltlady said:
Exactly. Highly educated people want the same for their children, which they are unlikely to find in rural America. People like to live around others of their same religion, ethnicity, whatever, and even a high salary doesn't buy that.
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There are plenty of rural communities in the South and elsewhere with a high minority population. A lot of times when people think of "rural medicine" their mind automatically goes to Appalachia. But there are underserved rural areas in almost every state, and all of them are different.
 
Considering the title of the thread, what did this have to do with Obamacare?
 
Sure you get a bigger salary, but this is a great example of when money can't buy you happiness. Not everybody will like living in a rural area.
 
Lol, more stupid pundits blathering on about how America has a shortage of doctors/nurses/scientists/plumbers/baristas/etc/etc. Someone needs to make a meme about this:

People complain about doctor shortage.
Medical schools reject thousands of qualified applicants every year.


I read an article in WSJ complaining about how there weren't enough STEM majors in colleges (particularly among women). Well, maybe there would be more STEM majors if science departments didn't haze them with crap like Organic Chem so the department could be rid of their presence. On one hand, colleges try to get rid of everyone that isn't the best in the science class. On the other, "hurrr durrrr we don't have enough science majors."

Get a clue.
 
HughMyron said:
Lol, more stupid pundits blathering on about how America has a shortage of doctors/nurses/scientists/plumbers/baristas/etc/etc. Someone needs to make a meme about this:

People complain about doctor shortage.
Medical schools reject thousands of qualified applicants every year.


I read an article in WSJ complaining about how there weren't enough STEM majors in colleges (particularly among women). Well, maybe there would be more STEM majors if science departments didn't haze them with crap like Organic Chem so the department could be rid of their presence. On one hand, colleges try to get rid of everyone that isn't the best in the science class. On the other, "hurrr durrrr we don't have enough science majors."

Get a clue.
Click to expand...


Omg you just simplified the whole problem, quick, call the dean of Hopkins and tell him!!
 
iforget2 said:
Sure you get a bigger salary, but this is a great example of when money can't buy you happiness. Not everybody will like living in a rural area.
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True, but if you love your job as a physician, you will spend most of the time at the hospital or In your house, and when vacation time comes up, you'll probably be gone anyways. Idk you're right everybody does had a different opinion, but I mean look at other options for completely paying off your loans, what are there, just the military?? Some kind of super scholarship. There's not a better offer IMO
 
Samiamm said:
True, but if you love your job as a physician, you will spend most of the time at the hospital or In your house, and when vacation time comes up, you'll probably be gone anyways. Idk you're right everybody does had a different opinion, but I mean look at other options for completely paying off your loans, what are there, just the military?? Some kind of super scholarship. There's not a better offer IMO
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And you'd be subjecting the rest of your family to having to live somewhere they hate just so you can make more money. You want to raise your kids at a good school, want your wife to be able to make friends, socialize, shop, eat good food, etc, most of which can't be easily done in very small communities in the middle of nowhere. You're probably far from relatives, far from the places you find familiar, and so forth.

And from and I've heard, the job usually entails a ton more work than you'd have to do otherwise. If you're the only [insert subspecialty here] in that town, you're going to be the only [subspecialty] on call 24/7. Someone needs neurosurgery? Hop in your Ferrari and head to the hospital, you're the only person who can do it.

There are many drawbacks to going rural. It can pay well, but there's a good reason why they have to pay well.

A urologist doing a urologic oncology fellowship told me he was offered $800,000 to work at a rural town in Alabama. He turned it down, saying he'd hate to live in rural Alabama. There's more than just the salary to consider.
 
Samiamm said:
....I think you should read the OP again
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But seriously, what does it have to do with Obamacare? What that more people are gonna be on Medicaid now? It's not like most of those people didn't need medical care before they just have crappy gov insurance now that most doctors won't take anyway unless they work in an FQHC.
 
There are a ton of IMGs that are fully qualified and would love to work in the US if given the chance.
 
I'm the odd-one-out. I grew up in a rural-ish area and am terrified of living in the big city.
 
quiltlady said:
Students still won't want to work in inner cities or in the hinterlands, no matter how many additional seats are created in med schools. That's where the need for doctors is.
Click to expand...
what is wrong with innercity hospitals anyways? that is where I want to work. but on the flipside, if I could live in a semi-rural area and make more. I would in a heartbeat. I have always wanted to live out away from everything. any idea what pediatricans make if you live away from the city?
 
iforget2 said:
Sure you get a bigger salary, but this is a great example of when money can't buy you happiness. Not everybody will like living in a rural area.
Click to expand...
I've lived in both and I would prefer a rural area to a city. Getting paid more to do it is just icing on the cake.

I don't get why people are so deadset on cities. It's not like you're going to be living up the nightlife when you're in your 40s, and property values, parking, and traffic are absolutely ******ed in a lot of cities. Seriously, have fun making $400,000 a year and living like you make $40,000, and then dying of an aneurism when your middle cerebral artery explodes from the stress of having a three mile commute that takes half an hour to drive (I've actually had that commute btw).

HughMyron said:
I read an article in WSJ complaining about how there weren't enough STEM majors in colleges (particularly among women). Well, maybe there would be more STEM majors if science departments didn't haze them with crap like Organic Chem so the department could be rid of their presence. On one hand, colleges try to get rid of everyone that isn't the best in the science class. On the other, "hurrr durrrr we don't have enough science majors."
Click to expand...

The claim that there aren't enough science majors is a myth. The reality is that there are actually too many scientists. Note that I said "scientists", not "science majors". The glut is so bad that each year US graduate schools graduate twice as many PhDs as there are positions open in academia. I won't even bother talking about the situation with science BS/BA holders since a basic science bachelor's degree would be worthless even without a glut.

Even "real world" bachelor degrees are glutted though. For example, Silicon Valley likes to complain about a shortage of computer scientists even as they lay off their own programmers in favor of outsourcing those jobs to Chinese and Indian programmers. While it is true that there are some shortages in engineering, it's only true for certain fields of engineering, and some of those fields are cyclical in their demand (ex: petroleum engineering).

This is why I'm dubious when I hear that there's a shortage of doctors. You really have to question where people are getting the information to base that claim from (for example, all the claims that there's a shortage of scientists stems from two very methodologically flawed studies conducted by the NIH that even the NIH admits couldn't have been more wrong in their conclusions). The only reason I don't dismiss the claim outright is that medicine, unlike all other fields of science, has a ridiculous bottleneck at the level of medical school admissions that seemingly ensures that the physician job market can never become glutted. As much as we all complain about the absurd demands of medical school admissions, it is those very same absurd admissions requirements that keep the career as attractive as it is.
 
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OCDOCDOCD said:
I've lived in both and I would prefer a rural area to a city. Getting paid more to do it is just icing on the cake.

I don't get why people are so deadset on cities. It's not like you're going to be living up the nightlife when you're in your 40s, and property values, parking, and traffic are absolutely ******ed in a lot of cities. Seriously, have fun making $400,000 a year and living like you make $40,000, and then dying of an aneurism when your middle cerebral artery explodes from the stress of having a three mile commute that takes half an hour to drive (I've actually had that commute btw).



The claim that there aren't enough science majors is a myth. The reality is that there are actually too many scientists. Note that I said "scientists", not "science majors". The glut is so bad that each year US graduate schools graduate twice as many PhDs as there are positions open in academia. I won't even bother talking about the situation with science BS/BA holders since a basic science bachelor's degree would be worthless even without a glut.

Even "real world" bachelor degrees are glutted though. For example, Silicon Valley likes to complain about a shortage of computer scientists even as they lay off their own programmers in favor of outsourcing those jobs to Chinese and Indian programmers. While it is true that there are some shortages in engineering, it's only true for certain fields of engineering, and some of those fields are cyclical in their demand (ex: petroleum engineering).

This is why I'm dubious when I hear that there's a shortage of doctors. You really have to question where people are getting the information to base that claim from (for example, all the claims that there's a shortage of scientists stems from two very methodologically flawed studies conducted by the NIH that even the NIH admits couldn't have been more wrong in their conclusions). The only reason I don't dismiss the claim outright is that medicine, unlike all other fields of science, has a ridiculous bottleneck at the level of medical school admissions that seemingly ensures that the physician job market can never become glutted. As much as we all complain about the absurd demands of medical school admissions, it is those very same absurd admissions requirements that keep the career as attractive as it is.
Click to expand...

The real bottleneck is residency training, not medical school. Graduating from medical school entitles you to exactly zero privileges as a physician without doing at least an internship.

(sent from my phone)
 
Samiamm said:
....I think you should read the OP again
Click to expand...

Is it the increased patient load and resulting need for more doctors you are referring to? If so, I agree with Nick, the bottleneck is at the residency level. A huge number of FMGs/IMGs don't match.
 
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whatbout2morrow said:
Is it the increased patient load and resulting need for more doctors you are referring to? If so, I agree with Nick, the bottleneck is at the residency level. A huge number of FMGs/IMGs don't match.
Click to expand...

The OP is referencing a recent article in the NY Times entitled "Doctor Shortage Likely to Worsen With Health Law." It's by Annie Lowery and Robert Pear. If you Google it you can find the entire text for free.

The upshot is that physician supply has not kept up with demand, and bringing millions of people into the insurance pool (via the PPACA) will exacerbate this problem.
 
getting there is half the battle. I worked in south dakota for a year and having come from the city... it was hard. I have met many physicians here from urban areas who wound up here looking for work and they are happy. Life is less stressful and they make more $$. They get to practice what they love without killing themselves.

People are afraid of what they don't know and sometimes city life is way overrated.
 
Ok I'll try to clarify what I was getting at.

So with Obamacare, AAMC has estimated that there will be an extreme physician shortage, that will gradually increase with time. So with this increased shortage, proposals such as opening new medical schools and increasing class sizes have come about. What IM trying to get at is, if these new proposals are put through, getting into med school will be much easier. I'm not sure what will happen with residencies, but IMO, these proposals could lead the career of a physician down the same path lawyers took a while ago.
 
HughMyron said:
Lol, more stupid pundits blathering on about how America has a shortage of doctors/nurses/scientists/plumbers/baristas/etc/etc. Someone needs to make a meme about this:

People complain about doctor shortage.
Medical schools reject thousands of qualified applicants every year.


I read an article in WSJ complaining about how there weren't enough STEM majors in colleges (particularly among women). Well, maybe there would be more STEM majors if science departments didn't haze them with crap like Organic Chem so the department could be rid of their presence. On one hand, colleges try to get rid of everyone that isn't the best in the science class. On the other, "hurrr durrrr we don't have enough science majors."

Get a clue.
Click to expand...
-~-Tangent-~-
 
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NickNaylor said:
The real bottleneck is residency training, not medical school. Graduating from medical school entitles you to exactly zero privileges as a physician without doing at least an internship.

(sent from my phone)
Click to expand...
I was under the impression that there's still enough residency slots out there such that the risk of graduating from a US med school and not matching is small; even IMGs still manage to match each year.

Even if it was difficult to find any residency though as a US med grad though, I'm doubtful that the resulting bottleneck would be anywhere near as large as the one between undergrad and med school wherein only 8% of kids starting out as pre-med and less than 50% of those who apply to medical school each year actually make it into medical school.
 
there are definitely plenty of spots that could be taken by US grads instead of IMGs, but those may be in fields that more US grads are passing up (family, psych, etc)
 
OCDOCDOCD said:
I was under the impression that there's still enough residency slots out there such that the risk of graduating from a US med school and not matching is small; even IMGs still manage to match each year.

Even if it was difficult to find any residency though as a US med grad though, I'm doubtful that the resulting bottleneck would be anywhere near as large as the one between undergrad and med school wherein only 8% of kids starting out as pre-med and less than 50% of those who apply to medical school each year actually make it into medical school.
Click to expand...

Per the 2011 NRMP Charting Outcomes report, there were 20,101 US MD/DO graduates that entered the match. There were 21,940 residency positions available. The AAMC says that 17,364 medical students graduated in 2011. So you're correct in that there's a bit of room there, but really not that much; theoretically we could increase the number of graduating MDs/DOs by ~26% if we made a 1:1 correlation of US graduates to residency positions. My apologies for being incorrect though.

Whether or not increasing class sizes is enough to address the "shortage," who knows. As many others have said, though, the real problem doesn't seem to be the absolute number of physicians being minted each year. The problem is how they're distributed, i.e., they tend to concentrate in areas that are "desirable" while leaving large swaths of land uncovered. Increasing the number of graduating medical students isn't going to necessarily solve that problem. It would be interesting to look at physicians per capita by county; I imagine we would see tons of concentration along the coasts, a little less in the midwest and south, and very little in the "heartland."

Edit: There's an interesting essay on Stanford's website here http://www.stanford.edu/group/ruralwest/cgi-bin/drupal/content/rural-health-care that includes the maps that I mentioned, but unfortunately I can't get the animation to load...
 
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