Am I crazy for not supporting this? (AAMC residency petition)

[PL198]

I have kind of a silly thought. What if PCPs had shorter training. I mean what would happen if an aspiring PCP could go straight to medical school with a binding commitment to FP or primary care? Since there is such a large shortage, that would give incentive to fill spots by skipping undergrad. I realize this is somewhat of a ridiculous question but it's just a though.
Moreover, as population grows, won't there eventually be saturation in every field? I'm trying to picture how competitive medical school admissions will be in the next two decades.

huh, demand for doctors will go up as the population goes up, not sure what you're saying about saturation...

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[Dr Van Helsing]

huh, demand for doctors will go up as the population goes up, not sure what you're saying about saturation...

Me neither. In retrospect, my logic was erroneous. In my little world it feels like everyone wants to become a doctor, but I am just thinking from my own, unworldly perspective.

 

[Doudline]

Point to another county in the Americas that is both as diverse and successful as us. Historically, we had some of the most lax immigration policies in the world. Which wasn't saying much in the 18th and 19th centuries, but attracting people to go on a death-defying journey over the oceans back then wasn't easy, so we had to be welcoming. We didn't really tighten up immigration at all until 1880, which was only slightly restrictive, and then began ratcheting down in the late 1910s and on. Even with those changes, we still have nearly as many immigrants currently living in the United States as the next 5 most immigrated to countries combined. 45.79 million people have come (and are currently living) here in search of a better life. We've got some of the lowest total taxes of any developed economy, the highest average wages in the world when adjusted for PPP (care of some of the cheapest consumer goods, commodities, and housing in the developed world), fairly decent free speech laws (a guy like Fred Phelps would have been imprisoned long ago in France, Germany, or the UK), and what is historically a fairly decent economy (we're still doing better than most of the developed world post recession). America is awesome. I'm not saying it's the best country in the world, as different countries offer people different things, but if you want to make a decent life for yourself, America is alright.

'Murrica.

http://en.m.wikipedia.org/wiki/List_of_countries_by_average_wage

http://en.m.wikipedia.org/wiki/List_of_countries_by_foreign-born_population

As to how this relates to the main thread topic, more residency positions=more opportunity for FMGs (and AMGs)=America gets to remain one of the top destinations for foreign born physicians to immigrate to, because America is awesome.

You have stupid criteria tbh.

Let's consider this - the USA is the country which: occupies the most countries and commits the most terrorist actions -as defined by international law-every year; has the lowest income equality of all Western industrialized countries (as per the World Bank GINI index) and highest relative poverty rates; has the second-lowest social mobility (the ability to improve one's socio-economic status, aka "American Dream" or "making a decent life for yourself") of major Western countries (3 times less than that of Denmark).

Etc etc. Those are only a few verified measures that aren't influenced by racial diversity.
(Because we could speak of educational levels, health outcomes, political participation & more, but "immigrants".)

And lmao at your economic perspective.
The USA is the country that CAUSED the 2006-2007 crisis because of it's idiotic deregulations, and fiscal evasion is a pandemic yet you flatter yourself on "low tax rates".

Unless you are in the top ~10% this country is really ****ty to live in.

--------------------

I'd agree that racism, free speech & co are in a far better position here than in continental Europe, however.
We simply don't hear about it because they have very homogeneous country, although it's start to shown in France and Germany.

 

[PL198]

highest relative poverty rates is a pretty useless metric to use. impoverished in the USA and impoverished in india are two extremely extremely different things. social mobility is poor because people are lazy. nothing more. there's tons of opportunity. just a bunch of losers who dont want to take it.

Also in terms of policy, any nordic nation is a joke. Norway is the prime example where the government literally changes policy solely based on people creating youtube videos showing how stupid their policies are.

 

[Mad Jack]

You have stupid criteria tbh.

Let's consider this - the USA is the country which: occupies the most countries and commits the most terrorist actions -as defined by international law-every year; has the lowest income equality of all Western industrialized countries (as per the World Bank GINI index) and highest relative poverty rates; has the second-lowest social mobility (the ability to improve one's socio-economic status, aka "American Dream" or "making a decent life for yourself") of major Western countries (3 times less than that of Denmark).

Etc etc. Those are only a few verified measures that aren't influenced by racial diversity.
(Because we could speak of educational levels, health outcomes, political participation & more, but "immigrants".)

And lmao at your economic perspective.
The USA is the country that CAUSED the 2006-2007 crisis because of it's idiotic deregulations, and fiscal evasion is a pandemic yet you flatter yourself on "low tax rates".

Unless you are in the top ~10% this country is really ****ty to live in.

--------------------

I'd agree that racism, free speech & co are in a far better position here than in continental Europe, however.
We simply don't hear about it because they have very homogeneous country, although it's start to shown in France and Germany.

If you want to be solidly middle class, there are certainly better countries to go to in which it is easier to be middle class because the extremes have been flattened out and damn near everyone is middle class. If you want real wealth and to not depend on the state for your income and security in old age, America is the best shot you've got. I'm not going for "average," I'm going for "top 1-3%" and America is the best shot for a poor kid like me to reach that. Other countries have better mobility, but not to the upper extremes, only between quintiles.

 

[Mad Jack]

Alternatively, perhaps there could be pathways of significantly lower tuition for students who commit from the beginning to primary care specialties. Note that I do not consider "repayment" track to be the same thing, as they give students the chance to be drawn toward lucrative specialties while in school and abandon their plans to practice primary care.

Such programs may exist, but I am not aware of any.

They do. LECOM has one such program, but there's an MD one as well that I can't remember the name of. LECOM's PCSP gets you through med school and residency in six years with less than 150k in debt.

 

[Wordead]

I'm not a consumer myself, but money is pretty damn important. Try living or retiring without it. The excess money I can make in America versus most other nations allows me a much greater chance of retiring at a much younger age and being free to travel and do as I please while I'm still healthy enough to enjoy myself.

So far as Dubai and major Chinese cities have massive underclasses. They're less the land of opportunity and more the land of exploitation for anyone that isn't wealthy or highly educated.

I think you have a much, much rosier view of America than I do.

 

[Mad Jack]

I think you have a much, much rosier view of America than I do.

Hard not to when I worked my way from the bottom to the top. I'm probably fairly biased, honestly.

 

[Psai]

.

 

[jw3600]

Can't make an Omelette without breaking a few eggs.

I dunno why but I love the fact you (probably mistakenly) capitalized "Omelette." Like The Omelette is name of a dark historical period marking the complete machination of physicians in society.

 

[GunnerBMS]

lol you're one of those people that say anyone against gay marriage is a homophobe, arent you

Yes I do because it's the truth. #truth

 

[jakeislove]

I dunno why but I love the fact you (probably mistakenly) capitalized "Omelette." Like The Omelette is name of a dark historical period marking the complete machination of physicians in society.

Wasn't a mistake, LOL!

A proper name sounded more amusing.

 

[alpinism]

Let's not conflate things here. The nursing organizations have used the maldistribution of physicians as a cover to expand their scope of practice with savvy lobbying, nothing more. We do not, and likely will not have a "physician shortage", but a disproportionate amount of sub specialized physicians in large cities and "desirable locales". How expanding mid level provider scope is meant to alleviate this shortage is beyond me, since last I checked, most nurses want to make the most money in desirable areas also. Go figure.

Exactly.

The crux of the AAMC argument is that we'll have more seniors in the future who will need more doctors (both primary care and specialists).

https://www.aamc.org/download/386378/data/07252014.pdf

The problem is that their numbers are based upon the faulty assumption that more doctors always leads to better care.

They're essentially advocating for elderly patients to see as many generalists and specialists as possible during the last few years of their lives. Which, of course, isn't surprising considering that they're an advocacy organization whose job is to make money for medical schools and university hospitals, not improve patient care.

The Dartmouth Institute for health policy has been doing research on the "physician shortage" myth for years now.

http://www.nytimes.com/2006/07/10/o...87e668bc4&ei=5090&partner=rssuserland&emc=rss


Too Many Doctors in the House

By DAVID C. GOODMAN
Published: July 10, 2006
Hanover, N.H.

CAN we cure our ailing health care system by sending in more doctors? That is the treatment prescribed by the Association of American Medical Colleges, which has recommended increasing the number of doctors they train by 30 percent, in large part to keep up with the growing number of elderly patients. But the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured — cannot be solved by more doctors. In fact, that approach, like prescribing more drugs for an already overmedicated patient, may only make things worse.

Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists, according to The Dartmouth Atlas of Health Care, a study of American health care markets (for which I am an investigator).

The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?

Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors. And various studies have demonstrated that the essential quality of care in places like Miami — whether you are talking about the treatment of colon cancer, heart attacks or any other specific ailment — is no higher than in cities like Minneapolis.

Studies of individual hospitals have likewise shown that while the doctor-patient ratio varies widely from place to place, more doctors do not mean better care.

The Mayo Clinic in Rochester, Minn., and the University of California, San Francisco, Medical Center each have about one doctor treating every 100 elderly patients with chronic illnesses in their last six months of life. New York University Medical Center has 2.8 doctors for every 100 such patients and the University of California, Los Angeles, Medical Center has 1.7. The elderly patients at N.Y.U. and U.C.L.A., as compared with those at the Mayo Clinic and the San Francisco hospital, see more specialists and are subjected to more imaging tests and other procedures. But the quality of their care, as judged by doctors, is no better.

Using the N.Y.U. doctor-patient ratio as a benchmark for determining the number of physicians that will be needed to care for the over-65 population in the year 2020, we can project a deficit of more than 44,000 doctors nationwide. But if the benchmark is based on the Mayo ratio, we can project an excess of nearly 50,000 doctors in the year 2020.

How can it be that more spending and greater physician effort does not lead to better health or to improvements in patient satisfaction? One explanation may be that when more doctors are around, patients spend more time in hospitals, and hospitals are risky places. More than 100,000 deaths a year are estimated to be caused by medical mishaps.

The association of medical colleges has argued that increasing the doctor supply overall can remedy regional shortages. But in the past 20 years, as the number of doctors per capita grew by more than 50 percent, according to our measurements, most of the new ones settled in areas where the supply was already above average — places like Florida or New York — rather than in regions that lack doctors, like the rural South.Medical training is an expensive business, and it makes little sense to waste additional public dollars to perpetuate doctors' preference to live in affluent places.

By training more doctors than we need, we will continue to fill more hospital beds, order more diagnostic tests — in short, spend more money. But our resources would be better directed toward improving efforts to prevent illness and manage chronic ailments like diabetes and heart disease.

Better coordination of care is also worth investment. Small physician groups in disconnected offices often provide fragmented treatments, while multispecialty practices integrated with hospitals — prevalent in Minneapolis and some other cities — are associated with lower cost and higher quality of care.

All these strategies have been shown to improve patient outcomes without adding physicians. Instead of training more doctors, let's make better use of the ones we already have.

David C. Goodman is a professor of pediatrics and family medicine at Dartmouth Medical School.

 

[PL198]

Exactly.

The crux of the AAMC argument is that we'll have more seniors in the future who will need more doctors (both primary care and specialists).

https://www.aamc.org/download/386378/data/07252014.pdf

The problem is that their numbers are based upon the faulty assumption that more doctors always leads to better care.

They're essentially advocating for elderly patients to see as many generalists and specialists as possible during the last few years of their lives. Which, of course, isn't surprising considering that they're an advocacy organization whose job is to make money for medical schools and university hospitals, not improve patient care.

The Dartmouth Institute for health policy has been doing research on the "physician shortage" myth for years now.

http://www.nytimes.com/2006/07/10/o...87e668bc4&ei=5090&partner=rssuserland&emc=rss


Too Many Doctors in the House

By DAVID C. GOODMAN
Published: July 10, 2006
Hanover, N.H.

CAN we cure our ailing health care system by sending in more doctors? That is the treatment prescribed by the Association of American Medical Colleges, which has recommended increasing the number of doctors they train by 30 percent, in large part to keep up with the growing number of elderly patients. But the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured — cannot be solved by more doctors. In fact, that approach, like prescribing more drugs for an already overmedicated patient, may only make things worse.

Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists, according to The Dartmouth Atlas of Health Care, a study of American health care markets (for which I am an investigator).

The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?

Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors. And various studies have demonstrated that the essential quality of care in places like Miami — whether you are talking about the treatment of colon cancer, heart attacks or any other specific ailment — is no higher than in cities like Minneapolis.

Studies of individual hospitals have likewise shown that while the doctor-patient ratio varies widely from place to place, more doctors do not mean better care.

The Mayo Clinic in Rochester, Minn., and the University of California, San Francisco, Medical Center each have about one doctor treating every 100 elderly patients with chronic illnesses in their last six months of life. New York University Medical Center has 2.8 doctors for every 100 such patients and the University of California, Los Angeles, Medical Center has 1.7. The elderly patients at N.Y.U. and U.C.L.A., as compared with those at the Mayo Clinic and the San Francisco hospital, see more specialists and are subjected to more imaging tests and other procedures. But the quality of their care, as judged by doctors, is no better.

Using the N.Y.U. doctor-patient ratio as a benchmark for determining the number of physicians that will be needed to care for the over-65 population in the year 2020, we can project a deficit of more than 44,000 doctors nationwide. But if the benchmark is based on the Mayo ratio, we can project an excess of nearly 50,000 doctors in the year 2020.

How can it be that more spending and greater physician effort does not lead to better health or to improvements in patient satisfaction? One explanation may be that when more doctors are around, patients spend more time in hospitals, and hospitals are risky places. More than 100,000 deaths a year are estimated to be caused by medical mishaps.

The association of medical colleges has argued that increasing the doctor supply overall can remedy regional shortages. But in the past 20 years, as the number of doctors per capita grew by more than 50 percent, according to our measurements, most of the new ones settled in areas where the supply was already above average — places like Florida or New York — rather than in regions that lack doctors, like the rural South.Medical training is an expensive business, and it makes little sense to waste additional public dollars to perpetuate doctors' preference to live in affluent places.

By training more doctors than we need, we will continue to fill more hospital beds, order more diagnostic tests — in short, spend more money. But our resources would be better directed toward improving efforts to prevent illness and manage chronic ailments like diabetes and heart disease.

Better coordination of care is also worth investment. Small physician groups in disconnected offices often provide fragmented treatments, while multispecialty practices integrated with hospitals — prevalent in Minneapolis and some other cities — are associated with lower cost and higher quality of care.

All these strategies have been shown to improve patient outcomes without adding physicians. Instead of training more doctors, let's make better use of the ones we already have.

David C. Goodman is a professor of pediatrics and family medicine at Dartmouth Medical School.

you're killing it right now

 

[Doudline]

If you want to be solidly middle class, there are certainly better countries to go to in which Tis easier to be middle class because the extremes have been flattened out and damn near everyone is middle class. If you want real wealth and to not depend on the state for your income and security in old age, America is the best shot you've got. I'm not going for "average," I'm going for "top 1-3%" and America is the best shot for a poor kid like me to reach that. Other countries have better mobility, but not to the upper extremes, only between quintiles.

I doubt it.

Might be the easiest country to go from 1-3% to 0.XXX%, but certainly not from bottom 25-50% to 1-3%+.
If that qualifies the USA as the "most successful" country in the world, so be it.

 

[Mad Jack]

I doubt it.

Might be the easiest country to go from 1-3% to 0.XXX%, but certainly not from bottom 25-50% to 1-3%+.
If that qualifies the USA as the "most successful" country in the world, so be it.

Becoming wealthy is all about consistent, long-term investment with excess capital. On a numerical basis, the country in which citizens have the most disposable capital is the United States. We also have some of the lowest capital gains rates in the world, and favorable deductions that can be taken on investments. If you are smart, disciplined, and hard-working, you can crack your way into the top 3% range easily within your lifetime. The trouble is, everyone just consumes, consumes, consumes, so they end up drowning in their own debt buying **** they don't need. America isn't the best country in the world for getting by, but if you've got the talent and the brains, it's certainly the best for getting ahead for a person starting from zero capital.

 

[PL198]

I doubt it.

Might be the easiest country to go from 1-3% to 0.XXX%, but certainly not from bottom 25-50% to 1-3%+.
If that qualifies the USA as the "most successful" country in the world, so be it.

you know the only people that complain about lack of opportunity? the people that piss them away.

 

[masaraksh]

Here's a good rule of thumb: if the AAMC supports it, Tis probably not in your best interest. If AMSA supports it, Tis DEFINITELY not in your best interest.

Sign accordingly.

You forgot to add in PNHP (physicians for national health plan) to your list.

 

[GunnerBMS]

you know the only people that complain about lack of opportunity? the people that piss them away.

Clearly you've never been poor or disenfranchised. Mommy and Daddy give you endless opportunities, so you never pissed any of them away right?

 

[PL198]

Clearly you've never been poor or disenfranchised. Mommy and Daddy give you endless opportunities, so you never pissed any of them away right?

no they don't give me anything, I just don't feel like complaining about it is the solution

 

[GunnerBMS]

I can't decide which of the two of you is more insufferable.

No wait, I decided. At least @PL198 tries to have a discussion.

I'll have a discussion when the people in power, people like you, start listening.

 

[deleted480308]

I'll have a discussion when the people in power, people like you, start listening.

A student justice warrior armed with all the rhetoric of an undergrad intro to sociology course? How novel... :rollseyes:

 

[W19]

I put America's health and the freedom of talented physicians to come here if they choose above all else in regard to this topic. If a Nigerian doctor wants to gtfo of Africa and he's a fine researcher and talented physician, I'd rather him get a position than some bottom of the barrel applicant that failed his Steps a couple times and barely scraped by to pass medical school. Forcing PDs to accept worse applicants just because they're US educated is bad for the medical profession, bad for society, and bad for the talented people we force out of the process. The only people that win with US first match policies are the borderline applicants that they would protect. I don't give a damn about them, I want the best, most talented colleagues possible regardless of where they happen to have been educated.

You don't think it's bad for society when a physician left his home country (i.e Nigeria) where lack of care is a huge problem... I guess if he/she comes to America, it's best for society. Not a good argument IMO...

Why make the exception for FMG --not Caribbean students?

 

[W19]

Unless you are ESL, in which case the pass rate drops markedly (and was pretty much the entire point of the exam, they just can't come out and say it that way)

Oh Boy! I am ESL; therefore, I should be on high alert for that CS then...

 

[W19]

As to the use of "America"- we use it because it makes sense given the name they decided to call our country. The United States us a descriptor, America is our name. If we'd gone communist we'd probably have been the United Socialist States of America, or if we didn't have states we'd have been the Democratic Republic of America. But for the same reason we didn't call the Democratic Republic of the Congo the Democratic Republic, we don't have to call the United States of America the United States if we don't feel like it. We're not called "United Statesians,"

By the way, you can say that... in Spanish.

 

[Mad Jack]

You don't think it's bad for society when a physician left his home country (i.e Nigeria) where lack of care is a huge problem... I guess if he/she comes to America, it's best for society. Not a good argument IMO...

Why make the exception for FMG --not Caribbean students?

They can accept whomever they want. But I've never seen a Carib grad and Yale or MGH categorical IM, while they'll generally take a solid FMG or two each year. Carib grads usually don't have secretly awesome resumes- they're often average applicants, not world class ones with highly regarded research or an established history of innovative medical practice.

As to health care access in other countries, I care most for that individual physician's right to live as they choose. If they would rather be in America than Nigeria and we are willing to take them, then they should follow their dreams.

 

[Mad Jack]

Exactly.

The crux of the AAMC argument is that we'll have more seniors in the future who will need more doctors (both primary care and specialists).

https://www.aamc.org/download/386378/data/07252014.pdf

The problem is that their numbers are based upon the faulty assumption that more doctors always leads to better care.

They're essentially advocating for elderly patients to see as many generalists and specialists as possible during the last few years of their lives. Which, of course, isn't surprising considering that they're an advocacy organization whose job is to make money for medical schools and university hospitals, not improve patient care.

The Dartmouth Institute for health policy has been doing research on the "physician shortage" myth for years now.

http://www.nytimes.com/2006/07/10/o...87e668bc4&ei=5090&partner=rssuserland&emc=rss


Too Many Doctors in the House

By DAVID C. GOODMAN
Published: July 10, 2006
Hanover, N.H.

CAN we cure our ailing health care system by sending in more doctors? That is the treatment prescribed by the Association of American Medical Colleges, which has recommended increasing the number of doctors they train by 30 percent, in large part to keep up with the growing number of elderly patients. But the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured — cannot be solved by more doctors. In fact, that approach, like prescribing more drugs for an already overmedicated patient, may only make things worse.

Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists, according to The Dartmouth Atlas of Health Care, a study of American health care markets (for which I am an investigator).

The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?

Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors. And various studies have demonstrated that the essential quality of care in places like Miami — whether you are talking about the treatment of colon cancer, heart attacks or any other specific ailment — is no higher than in cities like Minneapolis.

Studies of individual hospitals have likewise shown that while the doctor-patient ratio varies widely from place to place, more doctors do not mean better care.

The Mayo Clinic in Rochester, Minn., and the University of California, San Francisco, Medical Center each have about one doctor treating every 100 elderly patients with chronic illnesses in their last six months of life. New York University Medical Center has 2.8 doctors for every 100 such patients and the University of California, Los Angeles, Medical Center has 1.7. The elderly patients at N.Y.U. and U.C.L.A., as compared with those at the Mayo Clinic and the San Francisco hospital, see more specialists and are subjected to more imaging tests and other procedures. But the quality of their care, as judged by doctors, is no better.

Using the N.Y.U. doctor-patient ratio as a benchmark for determining the number of physicians that will be needed to care for the over-65 population in the year 2020, we can project a deficit of more than 44,000 doctors nationwide. But if the benchmark is based on the Mayo ratio, we can project an excess of nearly 50,000 doctors in the year 2020.

How can it be that more spending and greater physician effort does not lead to better health or to improvements in patient satisfaction? One explanation may be that when more doctors are around, patients spend more time in hospitals, and hospitals are risky places. More than 100,000 deaths a year are estimated to be caused by medical mishaps.

The association of medical colleges has argued that increasing the doctor supply overall can remedy regional shortages. But in the past 20 years, as the number of doctors per capita grew by more than 50 percent, according to our measurements, most of the new ones settled in areas where the supply was already above average — places like Florida or New York — rather than in regions that lack doctors, like the rural South.Medical training is an expensive business, and it makes little sense to waste additional public dollars to perpetuate doctors' preference to live in affluent places.

By training more doctors than we need, we will continue to fill more hospital beds, order more diagnostic tests — in short, spend more money. But our resources would be better directed toward improving efforts to prevent illness and manage chronic ailments like diabetes and heart disease.

Better coordination of care is also worth investment. Small physician groups in disconnected offices often provide fragmented treatments, while multispecialty practices integrated with hospitals — prevalent in Minneapolis and some other cities — are associated with lower cost and higher quality of care.

All these strategies have been shown to improve patient outcomes without adding physicians. Instead of training more doctors, let's make better use of the ones we already have.

David C. Goodman is a professor of pediatrics and family medicine at Dartmouth Medical School.

There are compounding factors in regard to Florida in that example. Florida has the worst medical malpractice environment in the country, and this doctors need to do every last possible intervention to avoid having their butts sued clean off. You have to practice differently in a dangerous medmal environment, that's just reality.

And the last bit really bothers me. Of course physicians giving up their autonomy and joining large groups rather than being in private practice is more efficient, but it also degrades the quality of the doctor-patient relationship and turns out once great profession into just another group of employees to be milked by large corporate entities and the government.

 

[W19]

They can accept whomever they want. But I've never seen a Carib grad and Yale or MGH categorical IM, while they'll generally take a solid FMG or two each year. Carib grads usually don't have secretly awesome resumes- they're often average applicants, not world class ones with highly regarded research or an established history of innovative medical practice.

As to health care access in other countries, I care most for that individual physician's right to live as they choose. If they would rather be in America than Nigeria and we are willing to take them, then they should follow their dreams.

If you care for the individual, that is one thing, but label that as 'best for society'............ and you seem to like using anecdotes to make your point...

 

[GunnerBMS]

A student justice warrior armed with all the rhetoric of an undergrad intro to sociology course? How novel... :rollseyes:

At least I actually care about justice. It seems I can't say the same for you.

 

[Mad Jack]

If you care for the individual, that is one thing, but label that as 'best for society'............ and you seem to like using anecdotes to make your point...

The individual wins by getting a better life and the resources to maximize their potential as a physician. American society wins because we get am awesome physician. It's a win-win.

If Nigeria wants to keep their physicians, they should find a way to either train more of them, carefully select the ones that will stay, provide better incentives for them to stay, or some combination of the above. Regardless, I care about America having the best physicians and how those physicians can benefit American society. We can't fix the whole rest of the world, but we can improve the lives of a few physicians that want to come here and make better lives for themselves.

 

[Mad Jack]

At least I actually care about justice. It seems I can't say the same for you.

He cares about justice, you just have different views of what is just.

 

[Dave89]

The phrase "______ come here seeking a better life" ought to be exposed and understood as the vacuous platitude that it is.

A rapist is also seeking a better life in committing his crime.

 

[W19]

The individual wins by getting a better life and the resources to maximize their potential as a physician. American society wins because we get am awesome physician. It's a win-win.

If Nigeria wants to keep their physicians, they should find a way to either train more of them, carefully select the ones that will stay, provide better incentives for them to stay, or some combination of the above. Regardless, I care about America having the best physicians and how those physicians can benefit American society. We can't fix the whole rest of the world, but we can improve the lives of a few physicians that want to come here and make better lives for themselves.

I care ONLY about America... screw everybody else.

 

[Mad Jack]

I care ONLY about America... screw everybody else.

In regard to immigration policy and the personal freedoms of people to immigrate to our country, yes. I value potential Americans and how they might benefit America more than I value the opinions or needs of the countries from which they come. America is my number one priority, the rest of the world is secondary.

 

[W19]

In regard to immigration policy and the personal freedoms of people to immigrate to our country, yes. I value potential Americans and how they might benefit America more than I value the opinions or needs of the countries from which they come. America is my number one priority, the rest of the world is secondary.

I hope as a physician you won't make a distinction between immigrants vs. americans

 

[Mad Jack]

I hope as a physician you won't make a distinction between immigrants vs. americans

American immigrants are Americans. Why would I treat them any different than other Americans? If they've got the cash to pay me, I'll see them, if they don't, I won't. Cash-only PP psych ftw.

 

[Entadus]

The phrase "______ come here seeking a better life" ought to be exposed and understood as the vacuous platitude that it is.

A rapist is also seeking a better life in committing his crime.

lol wut?

 

[ASD2019]

Exactly.

The crux of the AAMC argument is that we'll have more seniors in the future who will need more doctors (both primary care and specialists).

https://www.aamc.org/download/386378/data/07252014.pdf

The problem is that their numbers are based upon the faulty assumption that more doctors always leads to better care.

They're essentially advocating for elderly patients to see as many generalists and specialists as possible during the last few years of their lives. Which, of course, isn't surprising considering that they're an advocacy organization whose job is to make money for medical schools and university hospitals, not improve patient care.

The Dartmouth Institute for health policy has been doing research on the "physician shortage" myth for years now.

http://www.nytimes.com/2006/07/10/o...87e668bc4&ei=5090&partner=rssuserland&emc=rss


Too Many Doctors in the House

By DAVID C. GOODMAN
Published: July 10, 2006
Hanover, N.H.

CAN we cure our ailing health care system by sending in more doctors? That is the treatment prescribed by the Association of American Medical Colleges, which has recommended increasing the number of doctors they train by 30 percent, in large part to keep up with the growing number of elderly patients. But the most serious problems facing our health care system — accelerating costs, poor quality of care and the rising ranks of the uninsured — cannot be solved by more doctors. In fact, that approach, like prescribing more drugs for an already overmedicated patient, may only make things worse.

Many studies have demonstrated that quality of care does not rise along with the number of doctors. Compare Miami and Minneapolis, for example. Miami has 40 percent more doctors per capita than Minneapolis has, and 50 percent more specialists, according to The Dartmouth Atlas of Health Care, a study of American health care markets (for which I am an investigator).

The elderly in Miami are subjected to more medical interventions — more echocardiograms and mechanical ventilation in their last six months of life, for example — than elderly patients in Minneapolis are. This also means more hospitalizations, more days in intensive care units, more visits to specialists and more diagnostic tests for the elderly in Miami. It certainly leads to many more doctors employed in Florida. But does this expensive additional medical activity benefit patients?

Apparently not. The elderly in places like Miami do not live longer than those in cities like Minneapolis. According to the Medicare Current Beneficiary Survey, which polls some 12,000 elderly Americans about their health care three times a year, residents of regions with relatively large numbers of doctors are no more satisfied with their care than the elderly who live in places with fewer doctors. And various studies have demonstrated that the essential quality of care in places like Miami — whether you are talking about the treatment of colon cancer, heart attacks or any other specific ailment — is no higher than in cities like Minneapolis.

Studies of individual hospitals have likewise shown that while the doctor-patient ratio varies widely from place to place, more doctors do not mean better care.

The Mayo Clinic in Rochester, Minn., and the University of California, San Francisco, Medical Center each have about one doctor treating every 100 elderly patients with chronic illnesses in their last six months of life. New York University Medical Center has 2.8 doctors for every 100 such patients and the University of California, Los Angeles, Medical Center has 1.7. The elderly patients at N.Y.U. and U.C.L.A., as compared with those at the Mayo Clinic and the San Francisco hospital, see more specialists and are subjected to more imaging tests and other procedures. But the quality of their care, as judged by doctors, is no better.

Using the N.Y.U. doctor-patient ratio as a benchmark for determining the number of physicians that will be needed to care for the over-65 population in the year 2020, we can project a deficit of more than 44,000 doctors nationwide. But if the benchmark is based on the Mayo ratio, we can project an excess of nearly 50,000 doctors in the year 2020.

How can it be that more spending and greater physician effort does not lead to better health or to improvements in patient satisfaction? One explanation may be that when more doctors are around, patients spend more time in hospitals, and hospitals are risky places. More than 100,000 deaths a year are estimated to be caused by medical mishaps.

The association of medical colleges has argued that increasing the doctor supply overall can remedy regional shortages. But in the past 20 years, as the number of doctors per capita grew by more than 50 percent, according to our measurements, most of the new ones settled in areas where the supply was already above average — places like Florida or New York — rather than in regions that lack doctors, like the rural South.Medical training is an expensive business, and it makes little sense to waste additional public dollars to perpetuate doctors' preference to live in affluent places.

By training more doctors than we need, we will continue to fill more hospital beds, order more diagnostic tests — in short, spend more money. But our resources would be better directed toward improving efforts to prevent illness and manage chronic ailments like diabetes and heart disease.

Better coordination of care is also worth investment. Small physician groups in disconnected offices often provide fragmented treatments, while multispecialty practices integrated with hospitals — prevalent in Minneapolis and some other cities — are associated with lower cost and higher quality of care.

All these strategies have been shown to improve patient outcomes without adding physicians. Instead of training more doctors, let's make better use of the ones we already have.

David C. Goodman is a professor of pediatrics and family medicine at Dartmouth Medical School.

This is a wonderful article. The only question I have is are the number of midlevels the same at these institutions? Because I know the Mayo system is infested with PAs (and NPs). Are the number of medical personnel (docs and midlevels) significantly that different at these institutions? Or are doctors just being replaced by the cheaper midlevels at places like Mayo and UCSF?

 

[ASD2019]

And the last bit really bothers me. Of course physicians giving up their autonomy and joining large groups rather than being in private practice is more efficient, but it also degrades the quality of the doctor-patient relationship and turns out once great profession into just another group of employees to be milked by large corporate entities and the government.[/QUOTE]

Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.

 

[W19]

[/QUOTE]Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.[/QUOTE]

Good luck telling people to eat better, exercise, stop smoking and take their meds as prescribed....

 

[Psai]

Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.

Man you have no clue what you're talking about. How can you measure outcomes? What waste are you talking about? You talk like a politician. The most waste comes from prolonging the end of life. What do you mean by proven to work? Autonomy is being degraded every time that someone posts some bs study about what should be the standard of care and doctors are forced into lockstep by the threat of legal action. The doctor-patient relationship is degraded by having no time to actually talk to patients which is due to poor reimbursement by insurance companies and government along with onerous government mandates. There is no such thing as a health care team. It's individuals that are loosely connected but somehow doctors are supposed to bear the burden for other people's actions

 

[PL198]

Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.[/QUOTE]

Good luck telling people to eat better, exercise, stop smoking and take their meds as proscribed....[/QUOTE]

and here we are, the reason why chronic disease ratings in the USA are so terrible.

 

[ASD2019]

Man you have no clue what you're talking about. How can you measure outcomes? What waste are you talking about? You talk like a politician. The most waste comes from prolonging the end of life. What do you mean by proven to work? Autonomy is being degraded every time that someone posts some bs study about what should be the standard of care and doctors are forced into lockstep by the threat of legal action. The doctor-patient relationship is degraded by having no time to actually talk to patients which is due to poor reimbursement by insurance companies and government along with onerous government mandates. There is no such thing as a health care team. It's individuals that are loosely connected but somehow doctors are supposed to bear the burden for other people's actions

Many doctor's "good judgement" is basically based on the training they received. How they were taught to do things. Are all of these ways equally effective? What is so hard about measuring outcomes? You take a specific condition - look at which treatments for that specific condition have better patient outcomes - and you reward those doctors who can provide the best outcomes. Why should patients just trust us by mere faith? What is wrong with backing up your "good judgement" with scientific evidence? Doctors have autonomy as they will be the ones deciding what works and what doesn't. I am not for any mandates. It's actually more of a true "market" if you reward value.

There is some waste in these loosely connected network of providers (unnecessary repeating of tests, pt info not being communicated effectively, etc). Just look at how long it takes some patients to get the proper diagnosis. And I do agree with you that there are many other sources of waste in our system.

 

[Psai]

How can you measure outcomes? Let's say you're a cancer doctor and your outcomes are defined as length of life after diagnosis. You send all your hard cases to MD Anderson so your numbers look good and their cancer doctors' numbers look bad. They spent a lot more time and effort on their patients but their patients live shorter lives because they are more difficult cases. So should the MD Anderson doctors be penalized for their poorer outcomes?

 

[ASD2019]

Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.[/QUOTE]

Good luck telling people to eat better, exercise, stop smoking and take their meds as prescribed....[/QUOTE]

I think you misunderstood my point. The reimbursement isn't by each individual patient's outcome. It is for the overall outcome of patients with a specific condition who receive a specific treatment. For a system like this the reimbursements would be bundled and would take into account all of your patient outcomes. All providers will face difficult patients who don't comply with their advice so it isn't specific to any single provider. However, those providers who found ways to deal with these difficult patients (instead of just disregarding them) would be rewarded!

 

[ASD2019]

How can you measure outcomes? Let's say you're a cancer doctor and your outcomes are defined as length of life after diagnosis. You send all your hard cases to MD Anderson so your numbers look good and their cancer doctors' numbers look bad. They spent a lot more time and effort on their patients but their patients live shorter lives because they are more difficult cases. So should the MD Anderson doctors be penalized for their poorer outcomes?

Your are rewarding the treatment that works best for a specific condition. If by "hard case" you mean a different stage of cancer then that is a different condition.

 

[PL198]

Future reimbursement rates will probably be tied to patient outcomes thus favoring these large integrated groups. I actually think this is better for patients as it removes some waste from the system. Why not reward what is proven/shown to work instead of rewarding a doctor for doing what they were taught 20 years ago? I don't think this is necessarily taking away a doctor's autonomy. It is just holding them accountable for their autonomy. I also don't think it degrades the doctor-patient relationship. It just makes it a little different. Doctors will just have to find new ways to connect with their patients within their respective teams.

Good luck telling people to eat better, exercise, stop smoking and take their meds as prescribed....[/QUOTE]

I think you misunderstood my point. The reimbursement isn't by each individual patient's outcome. It is for the overall outcome of patients with a specific condition who receive a specific treatment. For a system like this the reimbursements would be bundled and would take into account all of your patient outcomes. All providers will face difficult patients who don't comply with their advice so it isn't specific to any single provider. However, those providers who found ways to deal with these difficult patients (instead of just disregarding them) would be rewarded![/QUOTE]

Right, so doctors who tell patients to lose weight, stop drinking, stop smoking and to exercise, when their entire population of patients fails to do so, then you punish them. There's no way to deal with them. You shouldn't have to jump through hoops to convince someone to take their own health seriously. If I don't study for my exams, I don't have a babysitter to tap my shoulder and say " you really need to do more," so why in the world would medicine be like that? It's removing the autonomy of the patients, because you're saying the physician needs to be more active for the patient to do what is recommended. No, I think they're perfectly capable, they just don't want to.

 

[Psai]

Your are rewarding the treatment that works best for a specific condition. If by "hard case" you mean a different stage of cancer then that is a different condition.

No that is not what I meant

 

[ASD2019]

Good luck telling people to eat better, exercise, stop smoking and take their meds as prescribed....

I think you misunderstood my point. The reimbursement isn't by each individual patient's outcome. It is for the overall outcome of patients with a specific condition who receive a specific treatment. For a system like this the reimbursements would be bundled and would take into account all of your patient outcomes. All providers will face difficult patients who don't comply with their advice so it isn't specific to any single provider. However, those providers who found ways to deal with these difficult patients (instead of just disregarding them) would be rewarded![/QUOTE]

Right, so doctors who tell patients to lose weight, stop drinking, stop smoking and to exercise, when their entire population of patients fails to do so, then you punish them. There's no way to deal with them. You shouldn't have to jump through hoops to convince someone to take their own health seriously. If I don't study for my exams, I don't have a babysitter to tap my shoulder and say " you really need to do more," so why in the world would medicine be like that? It's removing the autonomy of the patients, because you're saying the physician needs to be more active for the patient to do what is recommended. No, I think they're perfectly capable, they just don't want to.[/QUOTE]

lol that is a bit of an exaggeration. Most patients actually care about their health contrary to your believe. Like I said every provider has to face this problem. So this problem will be accounted for.

 

[ASD2019]

No that is not what I meant

Measurement of outcomes wouldn't be as simple as you make it. I myself don't really have a formula for measuring patient outcomes. It would take into account things like the state of the patient prior to receiving the treatment, other risk factors, laboratory testing, etc.

And the case you are making is for the few dishonest semi-fraudulent providers. There is no perfect system - regardless of whatever system - there will always be those that find how to milk it!