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This article came from the recent edition of Forbes magazine. There is also an article basically calling for the public lynching of all trial lawyers, check it out.
The Doctor Is Out
Heidi Brown, 07.21.03
The U.S. is frighteningly short of specialists. The problem could fix itself if policymakers would let the market take its course.
By the Numbers
5 Number of general radiologists currently serving Denton County, Texas, (pop. 433,000).
4 Number of jobs available per orthopedic surgeon nationwide.
150,000 Predicted shortfall of specialists by 2020.
25 Number of new medical schools needed to alleviate one-third the projected shortage of physicians.
Sources: Richard A. Cooper; Family Radiology; Staff Care.
Where did all the medical specialists go? Across the country, anesthesiologists, radiologists and child psychiatrists are in short supply, and consumers are paying the price--in higher fees, longer waits and sketchier care. In Wisconsin and Michigan young radiology residents with no board certification are working as full-time radiologists, without the knowledge of the patient or referring doctor. In New York women are waiting up to six months for a mammography screening. Ditto for patients at Thomas Jefferson Hospital in Philadelphia.
The number of specialists in the U.S. has not been growing quickly enough to meet the needs of a U.S. population that is both aging and expected to grow 18% between 2000 and 2020. Since the mid-1990s growth in the number of procedures performed has been 4.5% per year, while the number of specialists graduating per year has stayed flat. The Journal of the American Medical Association found in a 2000 study that demand for intensive-care doctors will outstrip supply by 35% over the next 30 years. "There's always been a shortage of specialists in rural areas," says Richard Cooper, a hematologist and director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee. "What's new is the shortage in urban areas, especially large teaching hospitals." Cooper foresees a 150,000-doctor shortfall by 2020.
Fatal errors are just waiting to happen. "A first-year radiology resident at my hospital was reading chest X rays to screen organ donors for cancer before transplant surgery," says Kelly Ludema, 35, assistant professor of radiology at Michigan State University. "Surgeons were going on the word of a first-year resident."
Cripplingly high premiums for medical malpractice insurance have taken most of the blame for the doc shortage, but an equally guilty party is the federal government's screwed-up method of allocating residency slots at medical schools. Congress has enormous influence over how many residency spots there are at each of the country's 126 medical schools and therefore over 73% of physicians entering the work force (the rest come from other countries). It does this through its control of Medicare, which funds many of the residency programs and fellowships that doctors use to get their specialty training.
In 1981 a panel established by the Department of Health & Human Services predicted that by 2000 the country would have 145,000 excess doctors. The fortune-tellers were a bit off. In 1993 a new panel made a similar prediction that by 2000 there would be 165,000 excess specialists. They figured that ascendant HMOs would use more primary-care docs, not brain surgeons. Specialist residency spots began vanishing. The bureaucrats didn't foresee the dizzying number of new specialized tests that so appeal to aging, affluent baby boomers. "We were wrong," admits Carl J. Getto, the panel's chairman and an associate dean at the University of Wisconsin Medical School.
Technologies such as teleradiology are an attempt to fill the gap. By zapping chest X rays over the Internet, radiologists in India can provide readings for internists at Johns Hopkins, Mayo Clinic and Harvard. It seems to be only a matter of time before remote diagnosis work gets shipped off to the Philippines, Australia and Malaysia.
But medicine needs the market to dictate what's needed and when. There's growing demand at some training hospitals and the American College of Radiologists to ease limitations on international medical students and physicians. Wealthy institutions such as Mayo Clinic and the Cleveland Clinic sponsor some residency programs the way employers sponsor M.B.A.s. This year Senator Jack Reed (D-R.I.) plans to reintroduce a bill to raise an additional $5 billion a year to fund residencies through a 1.5% assessment on private health insurance premiums. There was no action on the bill when it was first introduced in 1999.
The Doctor is Out
The Doctor Is Out
Heidi Brown, 07.21.03
The U.S. is frighteningly short of specialists. The problem could fix itself if policymakers would let the market take its course.
By the Numbers
5 Number of general radiologists currently serving Denton County, Texas, (pop. 433,000).
4 Number of jobs available per orthopedic surgeon nationwide.
150,000 Predicted shortfall of specialists by 2020.
25 Number of new medical schools needed to alleviate one-third the projected shortage of physicians.
Sources: Richard A. Cooper; Family Radiology; Staff Care.
Where did all the medical specialists go? Across the country, anesthesiologists, radiologists and child psychiatrists are in short supply, and consumers are paying the price--in higher fees, longer waits and sketchier care. In Wisconsin and Michigan young radiology residents with no board certification are working as full-time radiologists, without the knowledge of the patient or referring doctor. In New York women are waiting up to six months for a mammography screening. Ditto for patients at Thomas Jefferson Hospital in Philadelphia.
The number of specialists in the U.S. has not been growing quickly enough to meet the needs of a U.S. population that is both aging and expected to grow 18% between 2000 and 2020. Since the mid-1990s growth in the number of procedures performed has been 4.5% per year, while the number of specialists graduating per year has stayed flat. The Journal of the American Medical Association found in a 2000 study that demand for intensive-care doctors will outstrip supply by 35% over the next 30 years. "There's always been a shortage of specialists in rural areas," says Richard Cooper, a hematologist and director of the Health Policy Institute at the Medical College of Wisconsin in Milwaukee. "What's new is the shortage in urban areas, especially large teaching hospitals." Cooper foresees a 150,000-doctor shortfall by 2020.
Fatal errors are just waiting to happen. "A first-year radiology resident at my hospital was reading chest X rays to screen organ donors for cancer before transplant surgery," says Kelly Ludema, 35, assistant professor of radiology at Michigan State University. "Surgeons were going on the word of a first-year resident."
Cripplingly high premiums for medical malpractice insurance have taken most of the blame for the doc shortage, but an equally guilty party is the federal government's screwed-up method of allocating residency slots at medical schools. Congress has enormous influence over how many residency spots there are at each of the country's 126 medical schools and therefore over 73% of physicians entering the work force (the rest come from other countries). It does this through its control of Medicare, which funds many of the residency programs and fellowships that doctors use to get their specialty training.
In 1981 a panel established by the Department of Health & Human Services predicted that by 2000 the country would have 145,000 excess doctors. The fortune-tellers were a bit off. In 1993 a new panel made a similar prediction that by 2000 there would be 165,000 excess specialists. They figured that ascendant HMOs would use more primary-care docs, not brain surgeons. Specialist residency spots began vanishing. The bureaucrats didn't foresee the dizzying number of new specialized tests that so appeal to aging, affluent baby boomers. "We were wrong," admits Carl J. Getto, the panel's chairman and an associate dean at the University of Wisconsin Medical School.
Technologies such as teleradiology are an attempt to fill the gap. By zapping chest X rays over the Internet, radiologists in India can provide readings for internists at Johns Hopkins, Mayo Clinic and Harvard. It seems to be only a matter of time before remote diagnosis work gets shipped off to the Philippines, Australia and Malaysia.
But medicine needs the market to dictate what's needed and when. There's growing demand at some training hospitals and the American College of Radiologists to ease limitations on international medical students and physicians. Wealthy institutions such as Mayo Clinic and the Cleveland Clinic sponsor some residency programs the way employers sponsor M.B.A.s. This year Senator Jack Reed (D-R.I.) plans to reintroduce a bill to raise an additional $5 billion a year to fund residencies through a 1.5% assessment on private health insurance premiums. There was no action on the bill when it was first introduced in 1999.
The Doctor is Out
