What's the deal with the doctor and nurse shortage?

[RomaniGypsy]

Searched forums and came up with nothing, though I'm sure it's out there somewhere.

I keep hearing about how there is such a huge shortage of doctors and nurses, I imagine that mid-levels like NPs and PAs are included in that consideration.

Truth be told, I don't understand why this problem wouldn't have a relatively easy solution. From what I have gathered thus far, the following are the reasons why people who might want to go into medicine either don't go that route or "flame out" along the way:

1) Medical school is too difficult. (I wouldn't say that this should be changed. Doctors have to know their stuff.)

2) The work-life balance for residents, and often doctors, allows them no time with their families. (I don't see why residents must work 65+ hours per week. This could be reduced to a more manageable 40 or so, and then they wouldn't be as likely to "flame out". When people tell me, "your wife had better be prepared to be a single parent for the next 7-8 years and you will miss out on a lot of your son growing up", this brain that could handle medicine and this heart that wants to serve people says, "I'll pass".)

3) The culture pushes some people away. (I've heard of the phenomenon of "pimping", and I, for one, would never tolerate that kind of disrespect and cliqueishness. That isn't the only distasteful aspect of medical culture either, from what I've heard.)

4) Medical school is too expensive. (This could be changed. It doesn't need to cost a fortune, even if the cost were managed by more scholarships and government grants rather than a reduction in price. It's not like the federal and state governments are hurting for money. They could economize and increase efficiency in other ways... IF they wanted to...)

5) If you "flame out" along the way, or never "match" into a residency, you're left with all of that non-dischargeable student loan debt and nothing to show for it. (This is a major turn-off, for me at least.)

6) As a doctor, you are increasingly beholden to insurance companies and regulations, leaving you with less freedom and/or time to provide proper care than you would like. (This seems a major factor in the abnormally high rate of physician suicides.)

For nursing, it seems to be much the same. Long hours, tough requirements, poor work-life balance, ridiculous regulations, etc.

My question is simple. Can't something be done about this? If this is really a problem, what is stopping a solution? I imagine that, were a solution implemented, it'd take a lot of the burden off of all medical practitioners.

Or.... perhaps.... is it not as much of a problem as the media portrays it as being?

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[doc05]

Yes, it's a real problem. Your post is misguided, however, that's ok. The problem is because of demographics. Look it up.

 

[Fpg1245]

Searched forums and came up with nothing, though I'm sure it's out there somewhere.

I keep hearing about how there is such a huge shortage of doctors and nurses, I imagine that mid-levels like NPs and PAs are included in that consideration.

Truth be told, I don't understand why this problem wouldn't have a relatively easy solution. From what I have gathered thus far, the following are the reasons why people who might want to go into medicine either don't go that route or "flame out" along the way:

1) Medical school is too difficult. (I wouldn't say that this should be changed. Doctors have to know their stuff.)

2) The work-life balance for residents, and often doctors, allows them no time with their families. (I don't see why residents must work 65+ hours per week. This could be reduced to a more manageable 40 or so, and then they wouldn't be as likely to "flame out". When people tell me, "your wife had better be prepared to be a single parent for the next 7-8 years and you will miss out on a lot of your son growing up", this brain that could handle medicine and this heart that wants to serve people says, "I'll pass".)

3) The culture pushes some people away. (I've heard of the phenomenon of "pimping", and I, for one, would never tolerate that kind of disrespect and cliqueishness. That isn't the only distasteful aspect of medical culture either, from what I've heard.)

4) Medical school is too expensive. (This could be changed. It doesn't need to cost a fortune, even if the cost were managed by more scholarships and government grants rather than a reduction in price. It's not like the federal and state governments are hurting for money. They could economize and increase efficiency in other ways... IF they wanted to...)

5) If you "flame out" along the way, or never "match" into a residency, you're left with all of that non-dischargeable student loan debt and nothing to show for it. (This is a major turn-off, for me at least.)

6) As a doctor, you are increasingly beholden to insurance companies and regulations, leaving you with less freedom and/or time to provide proper care than you would like. (This seems a major factor in the abnormally high rate of physician suicides.)

For nursing, it seems to be much the same. Long hours, tough requirements, poor work-life balance, ridiculous regulations, etc.

My question is simple. Can't something be done about this? If this is really a problem, what is stopping a solution? I imagine that, were a solution


So we are accepting the claim that there is a shortage of physicians/nurses/PAs/NPs on what basis? Posters by the AAMC? The RAND corporation? Something you found on google? Color me skeptical regarding a nationwide physician shortage. Just because patients need to wait to see a doctor or drive a distance doesn’t mean there is a shortage. Much of the workforce “research” done is this area is a lot of agenda driven nonsense or the methods for calculating demand erroneous. If there is a shortage, surely not every specialty is in demand. We wouldn’t want to waste precious funds on training people to provide services the public doesn’t need.

 

[NITRAS]

#popcorn

 

[RomaniGypsy]

Yes, it's a real problem. Your post is misguided, however, that's ok. The problem is because of demographics. Look it up.

I have seen how demographics prevent shortages in certain areas - specifically the wealthier areas of the country, and the coasts. I've seen a map of "medically underserved areas" and it seems that, with few exceptions, wealthy areas and coastal areas are well-served while not-so-wealthy areas and areas that are otherwise not as desirable as places to live seem underserved.

I would be interested to see what doctors have to say about what could alleviate the shortage. I've read numerous articles about this and there do seem to be common threads. I would imagine that, without finding a good fix for this problem, it's going to become increasingly difficult for people to get basic health care unless doctors concede more of this domain to mid-level providers, which some seem unwilling to do.

 

[Moose A Moose]

Forty hours a week for residency?
C’mon, dude. By the end of this you’re expected to be competent enough to completely manage a patient autonomously. Really think about that; this isn’t nursing or PA training.

Also, nurses have an outstanding work:life balance.

Read up.

 

[RomaniGypsy]

Forty hours a week for residency?
C’mon, dude. By the end of this you’re expected to be competent enough to completely manage a patient autonomously. Really think about that; this isn’t nursing or PA training.

Also, nurses have an outstanding work:life balance.

Read up.

I have read up. I wouldn't come into a forum like this without having first read up.

Residencies can be 40 hours per week, even if that means they have to last for more years. I think it's high time that we start considering the fact that physicians are human beings too, and that the culture of medicine is a strong factor in driving an alarmingly high percentage of them to suicide. If a current residency is 80 hours per week, as seems to be the case on average, then the doctor would get the same number of clinical hours if the length of the residency were doubled and the hours worked per week were halved. Maybe some medical students really like the idea of working 80 hours per week and knocking the residency out quickly. That's fine for them and they should have the option of doing that. But some others wouldn't want to work 80 hours per week because they actually have a life outside of work. Doctors can manage patients autonomously at 40 hours per week - they just can't handle as many patients as could a doctor who works 60 hours per week. Nothing says that residents need to work 80 hours per week lest they never be able to achieve enough clinical hours to "know their craft" no matter how many years of 40 or 50 hours per week they work. 80 isn't a magic number. In fact, I would go so far as to say that given the wide proliferation of information about how people only have maybe 2-5 good hours per day to be really focused and really enthusiastic about what they do (depending upon the person), the point of diminishing returns (and perhaps increasing danger to the patients) is reached long before the end of yet another 12-16 hour shift. If the well-being of the patient is the primary concern of any doctor, then that doctor owes it to the patient to be well-rested and "fresh" when dealing with the patient.

As for nurses having a good work / life balance, I have read that it tends to be better than that for doctors. I suppose it's all in how they handle it. Their suicide rate is alarmingly high too, so something must be "off" in their world as well.

 

[NITRAS]

I have seen how demographics prevent shortages in certain areas - specifically the wealthier areas of the country, and the coasts. I've seen a map of "medically underserved areas" and it seems that, with few exceptions, wealthy areas and coastal areas are well-served while not-so-wealthy areas and areas that are otherwise not as desirable as places to live seem underserved.

I would be interested to see what doctors have to say about what could alleviate the shortage. I've read numerous articles about this and there do seem to be common threads. I would imagine that, without finding a good fix for this problem, it's going to become increasingly difficult for people to get basic health care unless doctors concede more of this domain to mid-level providers, which some seem unwilling to do.

Dude, its pretty simple. More people want to live in urban areas than rural ones. Most even take a substantial pay cut to work in "cool" places.
Rural areas means more time on call, and a more general practice. The trend in medicine is specialization, which really can't be practiced in an rural setting.

The idea that we need longer residencies would just make the problem worse. Your intervention cardiologist has been training for what, 11 years after at least a 4 year undergrad degree. I am not saying things are perfect, but a 40 hour week is not the answer, (and most salaried professionals work more than 40 hours a week btw.)

FYI, there is a big difference being knowing problems exist and having the knowledge and experience to have legitimate options on how to fix them. You don't.

 

[Black Coffee 24/7]

I have read up. I wouldn't come into a forum like this without having first read up.

Residencies can be 40 hours per week, even if that means they have to last for more years. I think it's high time that we start considering the fact that physicians are human beings too, and that the culture of medicine is a strong factor in driving an alarmingly high percentage of them to suicide. If a current residency is 80 hours per week, as seems to be the case on average, then the doctor would get the same number of clinical hours if the length of the residency were doubled and the hours worked per week were halved. Maybe some medical students really like the idea of working 80 hours per week and knocking the residency out quickly. That's fine for them and they should have the option of doing that. But some others wouldn't want to work 80 hours per week because they actually have a life outside of work. Doctors can manage patients autonomously at 40 hours per week - they just can't handle as many patients as could a doctor who works 60 hours per week. Nothing says that residents need to work 80 hours per week lest they never be able to achieve enough clinical hours to "know their craft" no matter how many years of 40 or 50 hours per week they work. 80 isn't a magic number. In fact, I would go so far as to say that given the wide proliferation of information about how people only have maybe 2-5 good hours per day to be really focused and really enthusiastic about what they do (depending upon the person), the point of diminishing returns (and perhaps increasing danger to the patients) is reached long before the end of yet another 12-16 hour shift. If the well-being of the patient is the primary concern of any doctor, then that doctor owes it to the patient to be well-rested and "fresh" when dealing with the patient.

As for nurses having a good work / life balance, I have read that it tends to be better than that for doctors. I suppose it's all in how they handle it. Their suicide rate is alarmingly high too, so something must be "off" in their world as well.

Don't go into medicine then. Personally, I don't want to work with cupcakes who can't handle a 80-100 hrs/wk due to the circumstances of the situation. I want colleagues who can handle the burden and work together with me when shiet hits the fan in order to properly manage pts, so that all of us can have a good night sleep when we're done. I also don't want to work with weaklings who get offended at attendings for probing them with quests in order to encourage self-learning.

Lastly, I don't want to be an underpaid slave for an extra 1-3 years of my career. Better get ready to grind for 80-90 hrs/wk of intern year, even if you're planning to go into Family Medicine.

 

[sunshinefl]

Dude, its pretty simple. More people want to live in urban areas than rural ones. Most even take a substantial pay cut to work in "cool" places.
Rural areas means more time on call, and a more general practice. The trend in medicine is specialization, which really can't be practiced in an rural setting.

The idea that we need longer residencies would just make the problem worse. Your intervention cardiologist has been training for what, 11 years after at least a 4 year undergrad degree. I am not saying things are perfect, but a 40 hour week is not the answer, (and most salaried professionals work more than 40 hours a week btw.)

FYI, there is a big difference being knowing problems exist and having the knowledge and experience to have legitimate options on how to fix them. You don't.

One time a couple of my med school classmates and I were talking to a student in one of the psych graduate programs at our school. We were talking about physician shortage in rural areas, and how even loan forgiveness incentives to work there (if even still viable by then) weren’t enough to recruit people. She indignantly asked “but why aren’t the people in small towns good enough for you? Why did you go to medical school if you don’t want to help everyone?” I said “it’s nothing against the people. But I have to LIVE where I work. I can’t just teleport for my shift and then teleport home. And I would be miserable in an isolated, rural area.”

 

[Matthew9Thirtyfive]

Don't go into medicine then. Personally, I don't want to work with cupcakes who can't handle a 80-100 hrs/wk due to the circumstances of the situation. I want colleagues who can handle the burden and work together with me when shiet hits the fan in order to properly manage pts, so that all of us can have a good night sleep when we're done. I also don't want to work with weaklings who get offended at attendings for probing them with quests in order to encourage self-learning.

Lastly, I don't want to be an underpaid slave for an extra 1-3 years of my career. Better get ready to grind for 80-90 hrs/wk of intern year, even if you're planning to go into Family Medicine.

I’d much rather do a 3 year residency at 80 hours per week than a 6 year residency at 40.