Bottlenecks in Training Doctors

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ThisCouldBeYou

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Not sure I can post this, but someone sent this to me. It's an editorial section about the obstacles of seeing a doctors. Although it mentions the low rates of primary care doctors, especially for underserved areas, which is a cost factor, isn't the real shortage of doctors due to the limited numbers of residency programs which is established by AMA?

http://www.nytimes.com/2014/07/20/opinion/sunday/bottlenecks-in-training-doctors.html?module=Search&mabReward=relbias:w,{"1":"RI:9"}
The AMA has nothing to do with the funding or accreditation of residency programs.
 
Who does? There is some resistance to increase the number of residents.

Each specialty has an RRC (Residency Review Committee) that determines the maximum number of positions in any program. Generally speaking, the program limit for RRC accreditation in the surgical fields is based on the number and complexity of cases that can be supervised, leading to the verification of competency. Nonsurgical fields have standards associated with the depth and breadth of experience available at the site (among many others!).
The funding for the position is from federal GME (Medicare) monies (mostly).
 
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I think the big flaw here is there is no real doctor shortage nationally. It's a distribution problem. Few want to be a primary care doctor in an underserved area, if they can go to a more lucrative area and/or specialty. you can't fix that with more residency slots -- more people will just cause a worse glut in the popular areas, and the underserved will continue to be underserved. They are underserved for a reason and it's the same reason doctors don't want to move there. So not an easy fix, and the claim (by the NYT and others) that theres a "doctor shortage so we need more doctors" is incredibly superficial and shallow. But I doubt we have to worry -- taxpayers aren't going to be quick to pay millions toward training more rich doctors and few politicians are going to go out on that limb and suggest we throw lots more money into an already too expensive healthcare system to fund more residencies.

Instead what will likely happen is the government will throw NPs at the problem.
 
Good point ^. Is this same problem, not enough primary care physicians, the reason why there's such a backlog over at the VA hospitals? The way I see, the govt will nationalize medical care anyway. I just didn't realize Medicare was already the pivotal key.
 
Good point ^. Is this same problem, not enough primary care physicians, the reason why there's such a backlog over at the VA hospitals? The way I see, the govt will nationalize medical care anyway. I just didn't realize Medicare was already the pivotal key.

The VA hospital issue is actually a LOT more complicated than lack of primary care physicians. It resulted from a perfect storm of a lot of minor issues all happening at the same time and turning into a massive hurricane of crap.

First, The VA decided in 2008 that the old paper-only way of filing benefits claims was old, out of date, and really slow. So they made a plan to put the whole process on the computer so it could be done digitally. This in itself is a pretty awesome idea.

Second, In 2013, the VA decided to make some massive changes in the way that some claims worked. They made it a lot easier to receive benefits for Leukemia, Parkinson’s Disease, Heart Disease, Agent Orange Exposure, and (heres the bigggg one) PTSD. As you would expect this meant that the VA all the sudden got about 60 bajillion new claims flooding it.

Now lets go back to the digitization. 2013 was the year that the Paper system ended and the Digital Claims system went live. Whenever you bring out new software, almost by definition, no one knows what the hell they're doing. So the VA was getting twice as many claim requests at the same time that their process for handling claims completely changed. This is what caused the massive backlog. In other words, this isn't a Doctor problem, its a Paperwork problem.

.......Then it turns out a bunch of the higher ups in the VA hospitals decided they didn't want to look bad, so they pressured doctors to alter their patient records to make the backlog look better. Earlier this year, a whistleblower leaked that all this was going on, and the rest is history. Messed up, messed up, history.
 
Also lol if you think that the Federal Government is gonna nationalize anything anytime soon.
 
Also lol if you think that the Federal Government is gonna nationalize anything anytime soon.
^ They already do with Medicare. I have good friends whose parent is an internist and the mom is the office manager. Most of his patients are on Medicaid and the changes they've felt are devastating. They used to get paid when their patients got tests. No longer. The office visits have been cut to a fraction. etc. Around where I live, my regular doctor is now part of the hospital, not a private group practice. If you're telling me the govt isn't involved, you need to get out there.
 
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