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Number of DO's increase or decrease with new Health Care?

Started by nshalaby
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nshalaby

nshalaby

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So obviously everybody is familiar with the new universal health care that pasted. I was wondering what would happen to Dr.'s in general with this new type of system. I heard two stories: 1) Number of Dr.'s would increase because a lot of people are going to be covered than before. 2) Health care will see an increase in NP's, and decrease in Dr.'s because NP's are going to be much cheaper alternative for more family practice purpose.

I will admit that i am fairly ignorant on the whole topic and have been meaning to read a nonpartisan review on the bill itself but just have been busy. Any input or thoughts would be great...thanks
 
nshalaby said:
So obviously everybody is familiar with the new universal health care that pasted. I was wondering what would happen to Dr.'s in general with this new type of system. I heard two stories: 1) Number of Dr.'s would increase because a lot of people are going to be covered than before. 2) Health care will see an increase in NP's, and decrease in Dr.'s because NP's are going to be much cheaper alternative for more family practice purpose.

I will admit that i am fairly ignorant on the whole topic and have been meaning to read a nonpartisan review on the bill itself but just have been busy. Any input or thoughts would be great...thanks
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First, this new system is nothing more than smoke and mirrors.

There will already be more physicians graduating DO schools - new schools now open and new schools in the pipeline - but the fear of this new "socialist," "ObamaCare" or whatever new word people come up with has the baby boomer docs running for the hills. Smaller labor pool = greater demand for services. Greater demand for services = high compensation. They'll never mandate you go to work, but they have mandated coverage, which means they'll eventually be forced to raise compensation rates to get physicians to keep their offices open longer or work more days or play less golf.. umm no.

There is only one MD school opening while the carribean is growing and the domestic state budgets are in a bind. It'll work itself out and honestly, I think for the better for Doctors

Yes, I'll work as a hospitalist, but since I only make as much as I work, I may not want to work in certain organizations because the compensation is too low. Others will feel the same. That will force hospitals to increase their offering in order to get us to come in to work more often.
 
Tekar said:
First, this new system is nothing more than smoke and mirrors.

There will already be more physicians graduating DO schools - new schools now open and new schools in the pipeline - but the fear of this new "socialist," "ObamaCare" or whatever new word people come up with has the baby boomer docs running for the hills. Smaller labor pool = greater demand for services. Greater demand for services = high compensation. They'll never mandate you go to work, but they have mandated coverage, which means they'll eventually be forced to raise compensation rates to get physicians to keep their offices open longer or work more days or play less golf.. umm no.

There is only one MD school opening while the carribean is growing and the domestic state budgets are in a bind. It'll work itself out and honestly, I think for the better for Doctors

.
Click to expand...

Where did you get that figure from? By my count, it looks like their will be 9-11 new MD schools open by 2013
 
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Tekar said:
First, this new system is nothing more than smoke and mirrors.

There will already be more physicians graduating DO schools - new schools now open and new schools in the pipeline - but the fear of this new "socialist," "ObamaCare" or whatever new word people come up with has the baby boomer docs running for the hills. Smaller labor pool = greater demand for services. Greater demand for services = high compensation. They'll never mandate you go to work, but they have mandated coverage, which means they'll eventually be forced to raise compensation rates to get physicians to keep their offices open longer or work more days or play less golf.. umm no.

There is only one MD school opening while the carribean is growing and the domestic state budgets are in a bind. It'll work itself out and honestly, I think for the better for Doctors

Yes, I'll work as a hospitalist, but since I only make as much as I work, I may not want to work in certain organizations because the compensation is too low. Others will feel the same. That will force hospitals to increase their offering in order to get us to come in to work more often.
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Dont be so sure that they cant mandate you to work, at least indirectly. ER physicians have to see patients regardless of ability to pay and in california they passed legislation where patients had to be seen within a certain amount of days depending on the reason for the visit.

These things are good for the patient, but doctors dont have wait times for the fun of it, so in essence you must work more and harder or you will be violating the sanctions.
 
Dr Oops said:
Dont be so sure that they cant mandate you to work, at least indirectly. ER physicians have to see patients regardless of ability to pay and in california they passed legislation where patients had to be seen within a certain amount of days depending on the reason for the visit.
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Mandatory insurance means these people aren't going to the ER and refusing to pay the bill anymore but rather seeing a family physician for their ingrown toenail or seasonal flu. "The s**t's chess, it ain't checkers."
 
creativename said:
Mandatory insurance means these people aren't going to the ER and refusing to pay the bill anymore but rather seeing a family physician for their ingrown toenail or seasonal flu. "The s**t's chess, it ain't checkers."
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It means they'll go to the ER because it is covered and much more convenient than actually waiting for a PCP appointment.
 
My opinion ... there will be more DOs simply because more DO schools will expand. However, I can see the following points :

1. Less, simply because if HC really does start to look less and less appealing, there will be a smaller number of applicants, and a combination of this + expanding allo schools will mean more people will have option between DO and MD, and more will go MD. This is something silly in my opinion (which is probably biased), but never underestimate the reasoning skills of a pre-medical student

2. More, simply because the system is about to be bombarded and I saw something like they will need over 100k new docs. Don't personally see the perks, but people will still claw down the walls to get into it.

3. Same/constant. DO schools will continue opening, qualified applicants will continue taking the spots. I don't think this HC bill is really going to change all that much, nor do I think the amount of applicants would decrease even if it did. Most pre-meds seem to look at medicine as some sort of religious, inescapable calling.

4. More ... people will realize OMM is a cash cow, I will get my own Dr Oz type show and promote the hell out of DOs, we all profit and get free balloons from the AOA because of it. This is probably the most likely option.
 
Does anyone know if there is anything at all in the bill to address increasing residency spots? I don't quite see how 12+ new medical schools can open up without an increase in residencies to absorb all those new graduates.

Knowing Congress, my guess is that they probably didn't think about this at all.

^^JP: where did you read 100k shortage of physicians? The number I've seen is 40k or so. I figured that they were going simply going to churn out a bunch of PAs to deal with the shortage (since they can crank them out in about half the time of an MD/DO). A 100K physician shortage though, we can't make that up anytime soon just by increasing the number of mid-level providers.
 
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JaggerPlate said:
4. More ... people will realize OMM is a cash cow, I will get my own Dr Oz type show and promote the hell out of DOs, we all profit and get free balloons from the AOA because of it. This is probably the most likely option.
Click to expand...

:soexcited::soexcited::soexcited: YESSSS!!!!! I can't wait!
 
The deal in California about mandating a patient gets seen in a certain number of days is not the responsibility of the physician - it is the responsibility of the insurance company.

As for residency spots, there has been much discussion on this topic this year. For the first time, there were not enough spots in the scramble to accomodate all the US seniors trying to get a spot. Yes, there are more residency spots than US seniors, but there are spots going to DO students and FMGs. Who knows what ramifications this year's match results will have, if any, in the future.

I foresee more people going to the ED because it's "convenient". Just like they always have.
 
RG73 said:
Does anyone know if there is anything at all in the bill to address increasing residency spots? I don't quite see how 12+ new medical schools can open up without an increase in residencies to absorb all those new graduates.
Click to expand...

I recall this issue already being addressed, but the country already has shortages in residency spots that are filled with FMG's. I see residency spots increasing actually as hospitals are given the choice between paying providers 6 digit numbers for the increasing numbers or footing the bills for the salarys of residencies, which are less than nurses. Right now medicare pays hospitals for it, but I don't see that lasting.
 
JaggerPlate said:
My opinion ... there will be more DOs simply because more DO schools will expand. However, I can see the following points :

3. Same/constant. DO schools will continue opening, qualified applicants will continue taking the spots. I don't think this HC bill is really going to change all that much, nor do I think the amount of applicants would decrease even if it did. Most pre-meds seem to look at medicine as some sort of religious, inescapable calling.

4. More ... people will realize OMM is a cash cow, I will get my own Dr Oz type show and promote the hell out of DOs, we all profit and get free balloons from the AOA because of it. This is probably the most likely option.
Click to expand...

I agree with both of these. I hope I can get green balloons though.

On a serious note, my fp is a DO who doesn't really OMM. He said there was a niche market for it in our town. He has people ask about it all the time. One of my future class mates is a chiropractor who cannot get into the medicine side of potential treatments at all under his chiropractor license. He can't even recommend ibuprofen. People see all kinds of chiropractors for physical ailments. I do believe OMM is a potential cash cow as a tool in the family practice that can draw more people. I also think that it is an opening for all those patients with back pain or what have you that will now have insurance who find no relief from an ER after the Dilaudid wheres off.
 
JaggerPlate said:
My opinion ... there will be more DOs simply because more DO schools will expand. However, I can see the following points :

1. Less, simply because if HC really does start to look less and less appealing, there will be a smaller number of applicants, and a combination of this + expanding allo schools will mean more people will have option between DO and MD, and more will go MD. This is something silly in my opinion (which is probably biased), but never underestimate the reasoning skills of a pre-medical student
Click to expand...

I think the percentage of DO's will either stay the same or even decrease as new allopathic schools open up. Almost two dozen more are about to open up in the next few years, and the osteopathic profession can't keep up with that in my opinion w/o sacrificing quality.

JaggerPlate said:
2. More, simply because the system is about to be bombarded and I saw something like they will need over 100k new docs. Don't personally see the perks, but people will still claw down the walls to get into it.
Click to expand...

I think medicine will still be one of the most stable and well-paying professions.

JaggerPlate said:
4. More ... people will realize OMM is a cash cow, I will get my own Dr Oz type show and promote the hell out of DOs, we all profit and get free balloons from the AOA because of it. This is probably the most likely option.
Click to expand...

LOL
 
There are three new M.D. programs opening in California alone:
UC - Merced, UC - Riverside and The Scripps Research Institute.
Other new MD programs include:
Quinnipac (CT), Oakland University (MI), Central Michigan University (MI), Western Michigan University (MI), Cooper Medical School (NJ), Hofstra University (NY), King School of Medicine (TN), and University of Houston (TX).

So, there is more than ONE new M.D. program opening.

I actually disagree with the comment regarding the Carribbean growing (us there are more medical schools, but there is a significant lack of quality to the new programs). With the influx of M.D. and D.O. programs in the U.S. it is going to be harder and harder for IMG to get residency spots. While, I think the established programs (such as St. George) will continue to be successful with their placement into US residencies, it's going to be nearly impossible for the new schools.

As for physician salary for family practice physicians, it will go the way of pilot salaries. Those with experience and doing more complicated things will get paid a lot still (read Captain of Boeing 777), those just doing mundane day to day work (Captain of Canada Regional Jet) will be making less. That in my opinion is how it should be (coming from someone that aspires to be a general peds physician, I do feel that the relatively lower salary is justified).


MLT2MT2DO said:
Nowhere does that article say the nearly two dozen medical schools are "allopathic" I believe this figure includes both allopathic and osteopathic.
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DocHomer said:
I think the percentage of DO's will either stay the same or even decrease as new allopathic schools open up. Almost two dozen more are about to open up in the next few years, and the osteopathic profession can't keep up with that in my opinion w/o sacrificing quality.
Click to expand...

http://www.lcme.org/newschoolprocess.htm

I only count 6-7. Ironically, one is also the school in Florida that is looking to skirt the not for profit LCME rules. However, I guess you did say 'next few years' so there could be more.

I'm betting the AOA will continue expanding new schools, and they won't ever see a day when class sizes fill up.



DocHomer said:
I think medicine will still be one of the most stable and well-paying professions.
Click to expand...

Stable ... no doubt. I worry about the payment aspect sometimes ... especially because of the debt incurred.
 
You know Homer, I was just thinking about the new MD schools opening up, and I started to crunch some numbers ...

Okay, this really isn't very precise here, but the last bit of data I saw from AMCAS said that (last year/this year, unsure) 42,000 people applied, and 18,000 were accepted to MD schools. This gives somewhere around a 42-43% acceptance rate.

If 12 MD schools were added with an average class size between 150-200 (we'll use 175 in the example, probably large tbh), and if the number of applicants does NOT change (it will still increase) there would be 42k applied and 20,100 accepted, giving a rate of 47-48%. This really isn't huge and it's definitely not going to change the fact that a HUGE chunk of people will still apply both, still matriculate DO, etc.

I think the number of applicants will steadily rise, DO schools will still open at a greater rate than MD (it's quicker to open a DO school), and there will still be truckloads of qualified applicants who don't get in. My random numbers also don't really take into consideration the fact that some of these schools will cater to specific applicants (ie the research center in CA, some of the state schools, etc), number of applicants increasing, etc.
 
JaggerPlate said:
You know Homer, I was just thinking about the new MD schools opening up, and I started to crunch some numbers ...

Okay, this really isn't very precise here, but the last bit of data I saw from AMCAS said that (last year/this year, unsure) 42,000 people applied, and 18,000 were accepted to MD schools. This gives somewhere around a 42-43% acceptance rate.

If 12 MD schools were added with an average class size between 150-200 (we'll use 175 in the example, probably large tbh), and if the number of applicants does NOT change (it will still increase) there would be 42k applied and 20,100 accepted, giving a rate of 47-48%. This really isn't huge and it's definitely not going to change the fact that a HUGE chunk of people will still apply both, still matriculate DO, etc.

I think the number of applicants will steadily rise, DO schools will still open at a greater rate than MD (it's quicker to open a DO school), and there will still be truckloads of qualified applicants who don't get in. My random numbers also don't really take into consideration the fact that some of these schools will cater to specific applicants (ie the research center in CA, some of the state schools, etc), number of applicants increasing, etc.
Click to expand...

You do provide a good example. The increase doesn't change the picture all that much. I don't know if I'm being too cynical, but I think the powers that be on both sides don't want the physician pool to grow too big anyway. Then we may have too many docs and that would put downward pressure on salaries. It's in the professions' best interest to keep a perpetual shortage.
 
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JaggerPlate said:
http://www.lcme.org/newschoolprocess.htm

I only count 6-7. Ironically, one is also the school in Florida that is looking to skirt the not for profit LCME rules. However, I guess you did say 'next few years' so there could be more.
Click to expand...

I'm going by a NY Times article that threw that number out there. It is possible that a majority of future schools haven't even applied for Phase I accreditation yet.

JaggerPlate said:
I'm betting the AOA will continue expanding new schools, and they won't ever see a day when class sizes fill up.
Click to expand...

I just hope that they focus on residencies as well. It doesn't help the profession to have a majority of students entering ACGME-only programs.


JaggerPlate said:
Stable ... no doubt. I worry about the payment aspect sometimes ... especially because of the debt incurred.
Click to expand...

I definitely hear you. My prediction is that the gap between PCP and specialist salaries will close in the coming years. The former will get bumped up and the latter will see some cuts. I think it's unavoidable. In any event, there needs to be some type of policy to address the debt situation.
 
DocHomer said:
I'm going by a NY Times article that threw that number out there. It is possible that a majority of future schools haven't even applied for Phase I accreditation yet.



I just hope that they focus on residencies as well. It doesn't help the profession to have a majority of students entering ACGME-only programs.




I definitely hear you. My prediction is that the gap between PCP and specialist salaries will close in the coming years. The former will get bumped up and the latter will see some cuts. I think it's unavoidable. In any event, there needs to be some type of policy to address the debt situation.
Click to expand...

I just don't believe that the person giving u pills should be making as much money as the person cutting u open..maybe it's just me
 
Skippygonenuts said:
I just don't believe that the person giving u pills should be making as much money as the person cutting u open..maybe it's just me
Click to expand...
No they shouldn't. At the same time, it's going to be impossible to get people to go into primary care at the numbers they're needed if they don't do something to make it more attractive to graduates. Both graduate with the same amount of debt, which is something that I think is lost on the general public when they're complaining about how much a physician makes.
 
DocHomer said:
I'm going by a NY Times article that threw that number out there. It is possible that a majority of future schools haven't even applied for Phase I accreditation yet.
Click to expand...

Again, I don't see where this article says "allopathic". Are you just assuming by saying medical schools the article is referring to allopathic?
 
MLT2MT2DO said:
Again, I don't see where this article says "allopathic". Are you just assuming by saying medical schools the article is referring to allopathic?
Click to expand...

There's no reason to assume DO schools won't expand at an equal or greater rate to MD schools. Frankly, it's faster and easier to open a DO school, and people won't overlook this fact.
 
The new healthcare system will place a higher demand on primary care.
+
Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts.
=
There will be an increase in DO's.
There will be an increase in the need for faculty to teach at new Osteopathic schools.


Yes, there will also be an increase in mid levels but they too need supervision by a physician.

People receiving primary care that would not have had it prior to the reform should end up being healthier. Things like OMM and preventative type holistic healing should go a long way.
 
Skippygonenuts said:
I just don't believe that the person giving u pills should be making as much money as the person cutting u open..maybe it's just me
Click to expand...

I agree. I should have said that the disparity in incomes will decrease. However, they shouldn't get paid the same.
 
Irishfan said:
No they shouldn't. At the same time, it's going to be impossible to get people to go into primary care at the numbers they're needed if they don't do something to make it more attractive to graduates. Both graduate with the same amount of debt, which is something that I think is lost on the general public when they're complaining about how much a physician makes.
Click to expand...

That's why I said reimbursement rates will most likely increase. That is one way of encouraging more people to enter primary care.
 
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UpwardTrend said:
The new healthcare system will place a higher demand on primary care.
+
Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts.
=
There will be an increase in DO's.
There will be an increase in the need for faculty to teach at new Osteopathic schools.


Yes, there will also be an increase in mid levels but they too need supervision by a physician.

People receiving primary care that would not have had it prior to the reform should end up being healthier. Things like OMM and preventative type holistic healing should go a long way.
Click to expand...

That may change if there aren't enough PCP's. More and more states are granting greater autonomy to NP's, for example. In a couple of states, they can set up shop without any supervision as long as they operate within their scope of practice.
 
UpwardTrend said:
The new healthcare system will place a higher demand on primary care.
+
Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts.
=
There will be an increase in DO's.
There will be an increase in the need for faculty to teach at new Osteopathic schools.
Click to expand...

This seems to be the most obvious answer to me, no?
 
I would personally love this new health care to work out and the number of DO's to increase, however, I'm just worried about the salary of DO/MD in the near future...Now, understand Im not being narcissistic when I say this. I do NOT want to be a DO for money, however, it would be foolish to go into a career that will make it hard to compensate back all the loans you took out to get there(not to mention the time/rigor spend in med-school). I agree that there should be a change in health care, however, i dont agree with this change..but thats a different thread. 🙂
 
We need to overhaul the healthcare system. I just feel the government went about it the wrong way....as usual.
 
Master Deep said:
We need to overhaul the healthcare system. I just feel the government went about it the wrong way....as usual.
Click to expand...

I respect that you're concerned about the reform - we all should be. However, if you're going to criticize, you should be bringing up your proposals and reasoning along with it. There's enough crap flying around in all directions. Of all people, we who are going to be most involved in this should be watching our actions and words.
 
nshalaby said:
So obviously everybody is familiar with the new universal health care that pasted. I was wondering what would happen to Dr.'s in general with this new type of system. I heard two stories: 1) Number of Dr.'s would increase because a lot of people are going to be covered than before. 2) Health care will see an increase in NP's, and decrease in Dr.'s because NP's are going to be much cheaper alternative for more family practice purpose.

I will admit that i am fairly ignorant on the whole topic and have been meaning to read a nonpartisan review on the bill itself but just have been busy. Any input or thoughts would be great...thanks
Click to expand...

Better question: Will number of PHYSICIANS increase. DO has nothing to do with it. ?
 
Well, from talking briefly to a Nurse Practitioner, she seemed to think that the number of NP's and PA's would increase greatly in family practice because they are so much cheaper than a DO or MD. How much validity that statement has i cannot answer. But it does raise a good concern, if the government is in control of the medical field pay what will happen to the family practice Dr's? Again Im not interested in the field because of the pay, but no one wants to get 100K+ in debt and not have a decent paying job out of it.
 
nshalaby said:
Well, from talking briefly to a Nurse Practitioner, she seemed to think that the number of NP's and PA's would increase greatly in family practice because they are so much cheaper than a DO or MD. How much validity that statement has i cannot answer. But it does raise a good concern, if the government is in control of the medical field pay what will happen to the family practice Dr's? Again Im not interested in the field because of the pay, but no one wants to get 100K+ in debt and not have a decent paying job out of it.
Click to expand...

She's probably right ...

30+ million newly insured, means a lot more pressure on primary care, which is good, but is going to create a big need. As far as this meaning more DOs because they are 'trained for PC,' I disagree. If PC gets big and money comes back into it, you will see just as many MDs rushing into it as DOs ... simply because it's competitive, not because DOs are better suited for it.

My guess is that you're going to see a shift/separation in PC practices - practices (probably a lot of NP/PA) that are going to start popping up and seeing a lot of these newly insured and other practices (probably DO/MD more) that create more of the previous experience before the 'reform' and cater to the previously insured. I also wouldn't be surprised to if concierge model picked up a little bit of steam. People who have finances and solid insurance aren't going to want to go to clinics that see 500 patients a day as a result of the newly insured.

I also think we're going to see a BIG push into getting doctors into big/HMO type organizations (which is what the gov wants) under the guise of 'increased efficiency.' Whether or not docs will ... I dunno. They may have no choice, and some of these managed models will probably offer a nice straight salary with perks, which is attractive for a lot of docs.
 
I think DO schools seem to have larger enrollment. NYCOM, for example, has an average class size of around 300 - double the size of a lot of those at MD schools. Maybe that's why they're assuming more and more DOs?
 
I'm going to wager that if primary care physicians, be they FP, IM, Peds, or what have you, would be more apt to pursue primary care if they knew coming out of residency that they wouldn't have to constantly fight with insurance companies, Medicare, and Medicaid or be selective of their patient population knowing that many can't/won't pay.

I actually haven't followed the healthcare bill very closely so I'm not anyone to give a qualified opinion on the ultimate outcome of it all. It actually doesn't interest me. Once it's all said and done then I'll read about it. Regardless of what happens I know what I still want to do, yet if the bill does become a windfall for primary care I'm sure we'll see waves of people moving into take advantage of it. Why wouldn't they? A shorter residency leading to consistent income coupled with idealistic medicine would be quite the enticement.
 
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ArkansasRanger said:
I'm going to wager that if primary care physicians, be they FP, IM, Peds, or what have you, would be more apt to pursue primary care if they knew coming out of residency that they wouldn't have to constantly fight with insurance companies, Medicare, and Medicaid or be selective of their patient population knowing that many can't/won't pay.
Click to expand...

That is a wager you'd win. But the newly-passed legislation won't change any of that. In fact, you'll have only more of it.


ArkansasRanger said:
I actually haven't followed the healthcare bill very closely so I'm not anyone to give a qualified opinion on the ultimate outcome of it all. It actually doesn't interest me. Once it's all said and done then I'll read about it. Regardless of what happens I know what I still want to do, yet if the bill does become a windfall for primary care I'm sure we'll see waves of people moving into take advantage of it. Why wouldn't they? A shorter residency leading to consistent income coupled with idealistic medicine would be quite the enticement.
Click to expand...

I don't think it will be a windfall for primary care physicians. All we've done is add more people to an already strained and unbalanced system. The same problems will be there in greater numbers. Yes, PCP's will have more patients to see, but the administrative burden will continue to tax the system. Hopefully, they will adjust health care over time to address some of these issues.:xf:
 
DocHomer said:
That is a wager you'd win. But the newly-passed legislation won't change any of that. In fact, you'll have only more of it.




I don't think it will be a windfall for primary care physicians. All we've done is add more people to an already strained and unbalanced system. The same problems will be there in greater numbers. Yes, PCP's will have more patients to see, but the administrative burden will continue to tax the system. Hopefully, they will adjust health care over time to address some of these issues.:xf:
Click to expand...


Ahhhhh, I see. Like I said, I haven't kept up with any of it. I'd like to find a three paragraph or so synopsis of it all, but I'm not even that interested to search for it, lol.
 
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