Why aren't they making many new med schools? Paradox

[Happensinvegas]

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The medical world agrees that we need more doctors, especially of under-represented groups, but of all races as well. The trend I have seen is that there are the same amount of med schools year after year, even decade after decade with very few available seats. Schools only add 1-2 seats a year. As a result, the requirements to enter into med-school are ridiculously high. What I mean by ridiculous is that you need a 3.5 gpa and 30+ Mcat to get in. To be a successful doctor, you don't actually need those high stats. You can see this in med school students from 3-4 decades ago. Wouldn't it be a better solution for schools and the government to invest in the creation of med schools and increasing the capacity of current schools to accommodate the growing need of physicians? By doing this, we could keep entrance requirements at a more reasonable level (3.2gpa and 26+ Mcat) and make the availability of trained physicians more widespread?

Now here is a very controversial thought:

Many universities without med schools dump millions of dollars on semi-useless things that could be used to create med school. Examples of semi-useless things are the creation of a gender-studies department, renovating dorms that were already renovated 10 years ago, sponsoring random sports that don't bring in any profit,etc...

I feel that if we really want to fix this issue of a lack of doctors and even nurses, there should be an increase in institutions that train the required personnel or at least increase the capacity of these institutions.

 

[lhooq]

The trend I have seen is that there are the same amount of med schools year after year, even decade after decade with very few available seats. Schools only add 1-2 seats a year.

Actually, new schools are opening every year, and the number of medical student seats has increased in recent years; see https://www.aamc.org/newsroom/newsreleases/358410/20131024.html. Moreover, the issue isn't really the number of medical student seats available, it's the number of residency spots, which has been kept very steady. If we kept increasing the number of medical students without increasing the number of residency spots, then many medical school graduates would be left without residency placements.

 

[tortelliniboy]

no, there's plenty of new medical schools being opened and increasing seats of the existing ones. In fact there's a huge discussion, as ihooq alluded to, about how there's an uneven proportion of medical school seats to residency spots, please do more reading so that you will be more informed come interview time.

 

[Happensinvegas]

Actually, new schools are opening every year, and the number of medical student seats has increased in recent years; see https://www.aamc.org/newsroom/newsreleases/358410/20131024.html. Moreover, the issue isn't really the number of medical student seats available, it's the number of residency spots, which has been kept very steady. If we kept increasing the number of medical students without increasing the number of residency spots, then many medical school graduates would be left without residency placements.

Well an increase of residency spots should be worked out as a joint effort with the increase of medical school seats available. I saw that only 14 schools increased their class size by 10%. That could be a lot.....or not. Some med school classes are only 100 people big, so it could be that there was only an increase of 140 students (which is nothing compared to the future need). But a 10% increase by 14 schools is not enough of an effort.

I think if med schools did vastly increase class size and MANY more institutions opened up medical programs, it would put enough pressure on the government to increase residency spots

Edit: here's a list of newish medical schools from the aamc. They all have very small class sizes that, again, don't really help meet the need for new physicians (Go to page 7) https://members.aamc.org/eweb/uploa...ping Medical Schools in the US and Canada.pdf

 

[Oo Cipher oO]

The competitiveness of medical school is dictated by the cohort of applicants that apply to get in. Medicine is considered profitable and prestigious so many smart and talented people apply. A doctor shortage will not be fixed by medical size alone. There are plenty of foreign and international medical school graduates that apply for spots. The real rate limiting step is residency spots.

I don't think a 3.2 and 26 MCAT is necessarily reasonable nor desirable for medical school entrance.

 

[lhooq]

Examples of semi-useless things are the creation of a gender-studies department

How on earth is a Gender studies department useless?? Gender and sexuality studies is an important interdisciplinary academic field, and investing in a department dedicated to teaching and doing research on the subject is essential.

 

[lhooq]

I feel that if we really want to fix this issue of a lack of doctors and even nurses

The issue we have is really more of a doctor distribution problem than a doctor shortage one; we have plenty of physicians, it's just that we have too many specialists in saturated locations and not enough primary care physicians in rural / more undesirable areas.

 

[Happensinvegas]

The issue we have is really more of a doctor distribution problem than a doctor shortage one; we have plenty of physicians, it's just that we have too many specialists in saturated locations and not enough primary care physicians in rural / more undesirable areas.

Then let's get residency programs in these locations. It will help draw doctors to these areas.

 

[Gibbward]

How on earth is a Gender studies department useless?? Gender and sexuality studies is an important interdisciplinary academic field, and investing in a department dedicated to teaching and doing research on the subject is essential.

+100
I'm pretty sure understanding the needs and hardships of different genders and sexual orientations is important in the field of medicine. Just think about that for a second.

Quite simply, not everything revolves around medicine and being a doctor. Universities certainly do not think that way. Plus, I think you're underestimating just how expensive it is to establish a medical school. Spending a few hundred thousand dollars on dorm renovations is chump change compared to the millions needed to start up and maintain a medical school.

 

[Happensinvegas]

+100
I'm pretty sure understanding the needs and hardships of different genders and sexual orientations is important in the field of medicine. Just think about that for a second.

Quite simply, not everything revolves around medicine and being a doctor. Universities certainly do not think that way. Plus, I think you're underestimating just how expensive it is to establish a medical school. Spending a few hundred thousand dollars on dorm renovations is chump change compared to the millions needed to start up and maintain a medical school.

It's a little bit of money here and there that adds up. The cost to maintain a losing field hockey team (scholarships, field, equipment, coaches) is greater than how much revenue that sport develops. Dorm renovations are A LOT more than a few hundred thousand at most schools. Try a few million. I also am saying the government can contribute funding to create these schools because it is in the governments best interest to meet the need for doctors

 

[WingedOx]

I'm bookmarking this. We have a new high-water mark for the least-informed mansplaining thread on SDN this year. Anyone care to top it?

 

[tortelliniboy]

for the love of God, I know these are all just opinions but don't say these things during the interview. You'll not only be rejected, but also laughed at during the post-interview discussion for being so naive.

 

[hoihaie]

you don't need more med schools, you need more residency spots and better physician distribution

 

[MrLogan13]

Lowering admissions standards is not a good thing.

 

[Law2Doc]

The medical world agrees that we need more doctors...

1. Actually the medical world completely disagrees with this. There are plenty of doctors. The problem isn't one of volume, but distribution. Doctors all want to do derm or plastics in NYC or LA. Nobody wants to do OB in rural Montana. Graduating more physicians won't ever fix this problem, just worsen it.

2. As mentioned med schools are not the bottleneck, residency is-- you can open a thousand new schools and you still wouldn't generate a single additional doctor in four years. But we aren't going to increase residencies for two reasons. First, the AAMC is closing in on it's goal of having the number of US grads equal the number of residency slots, thereby driving the Caribbean out of the game. So until they meet that goal there won't be any real internal push to increase slots. Second, it's not cheap to train doctors. We aren't talking about reallocating a few measly bucks from dorm room renovations or hockey teams, we are talking fewer Apache helicopters or highways. And it's a very hard sell for politicians to get the public behind using their tax money for subsidizing the training of more soon to be rich dermatologists, particularly when times are tough and the general sentiment is that we are already spending way too much on healthcare.

There's no paradox here. The problems will be fixed by admitting more people with a professed interest in working in under-served communities, incentivizing people to go to the more rural areas, and by the fact that people trying to go to NY or LA eventually won't find jobs. Also, once the Caribbean students are out of the game we will see a push down effect, whereby the low end med students will end up being pushed into those spots formerly taken by FMGs, which will change the distribution and maybe may make certain areas seem more appealing. And in the government eyes, an NP at a CVS or Walmart is just as much a solution as an actual doctor, so liberalizing midlevel practice rights is going to be more and more of the overall landscape.

Finally, it's starting to get conceivable that within a matter of decades a skilled midlevel working in conjunction with a Watson-like computer might be able to handle some of the algorithm based functions of basic primary care, which could lessen the need for As many doctors. Won't ever replace doctors IMHO but will make for better evaluation of who actually needs a doctor versus who gets sent home with a z-pack or Tylenol without ever seeing one. This IMHO is the longterm cost effective approach to our healthcare "shortage", not more doctors.

 

[PreciousHamburgers]

It's a little bit of money here and there that adds up. The cost to maintain a losing field hockey team (scholarships, field, equipment, coaches) is greater than how much revenue that sport develops. Dorm renovations are A LOT more than a few hundred thousand at most schools. Try a few million. I also am saying the government can contribute funding to create these schools because it is in the governments best interest to meet the need for doctors

Since when is it about revenue? It's about education. The college experience is just as, if not more important than what you learn in the classroom. Seems like you don't understand that there is a world outside of medicine (and thankfully so). People who think like this are exactly who they are trying to keep out of medical schools.

 

[Cytokine2014]

Examples of semi-useless things are the creation of a gender-studies department

Gender studies departments are incredibly important. They are the major academic engine for sparking institutional change with regard to women and gender minorities, good ones are also LGBTQ friendly and actively antiracist. Calling that semi useless is misguided at best.

 

[Winged Scapula]

Since when is it about revenue? It's about education. The college experience is just as, if not more important than what you learn in the classroom. Seems like you don't understand that there is a world outside of medicine (and thankfully so). People who think like this are exactly who they are trying to keep out of medical schools.

Undergrad education has long been about revenue. There's a reason why more funding goes to men's football than swimming and why college instructors are asked to look the other way in regards to athletes class attendance and failing test scores.

Not that I would know anything about that.

 

[PreciousHamburgers]

Undergrad education has long been about revenue. There's a reason why more funding goes to men's football than swimming and why college instructors are asked to look the other way in regards to athletes class attendance and failing test scores.

Not that I would know anything about that.

Well, few things AREN'T about making money, but there are certainly much easier ways to generate revenue than providing a liberal arts education. You could sell a bare-bones education with no non-revenue generating sports, no clubs, etc, but few people would want to go to that institution, and the graduates would be less well-rounded (to put it nicely) than those that came from an institution that did offer those extracurricular activities.

I could also see someone viewing science departments as semi-useless if they thought the point of colleges was to produce humanities majors. That would be as misguided as OP's view.

 

[Winged Scapula]

Well, few things AREN'T about making money, but there are certainly much easier ways to generate revenue than providing a liberal arts education. You could sell a bare-bones education with no non-revenue generating sports, no clubs, etc, but few people would want to go to that institution, and the graduates would be less well-rounded (to put it nicely) than those that came from an institution that did offer those extracurricular activities.

I think the recent experience with Corinthian Colleges shows that there are plenty of people willing to go to those schools either because they don't know any better, have no family experience with traditional undergrad education, and they believe the hard sell ads.

The average working single parent in their mid 20s doesn't care about a football team or a well rounded liberal arts education; they want the promise of a better job and more money.

 

[PreciousHamburgers]

I think the recent experience with Corinthian Colleges shows that there are plenty of people willing to go to those schools either because they don't know any better, have no family experience with traditional undergrad education, and they believe the hard sell ads.

The average working single parent in their mid 20s doesn't care about a football team or a well rounded liberal arts education; they want the promise of a better job and more money.

Do you think Corinthian College grads would fair as well as the average grad from the average college in medical school interviews? Would they have as many experiences to draw from? Also, what are we arguing about? lol

 

[SouthernSurgeon]

So I think I'm feeding a troll, but here goes.

1. The cost of opening a brand new medical school: It's expensive. Particularly if you are talking about an MD school and have any aspirations of building a research enterprise. You have start up building costs for the actual physical space (look at how much new buildings run for on most college campuses as they expand), not to mention possible land acquisition issues as most colleges don't simply have a spare 100 acres laying around. Second you have to hire and retain a faculty and support staff. Third you have clinical rotation site requirements and affiliated staffing there. My undergrad actually looked into the idea of opening a med school seriously about a decade ago, and after getting input from consultants dropped the idea as cost prohibitive. Simply put - I'm not clear why the mission of every college should or needs to include medical education.

2. Residency positions vs med school seats. There seems to be some confusion here. While residency positions may serve as the final chokepoint for physician training, there is not, nor has there ever been, a residency shortage. Currently there are 1.4 residency positions for every US medical school graduate. While yes, the BBA did put a cap on residency funding, residency programs have continued to expand slowly but steadily since that time roughly matching the growth rate of medical schools. Within the past five years, there has finally been some more momentum to expand medical schools to roughly match the # of residency positions (projected to occur by ~2017-2020). However, 10 years ago they were predicting this would have already happened by about ~2012, so whether it actually reaches a bottleneck point remains to be seen.

3. Residency funding: Currently the government spends $15 billion per year subsidizing GME. Simply saying - "make MOAR doctors" is laughable, as the government is highly unlikely to just shove more money into the Medicare budget.

4. Residency expansion: This is even more difficult than medical school expansion. It takes a lot of resources to effectively train residents. It also takes a lot of patient volume, as each resident needs to take care of an adequate number of patients to get decent training. Most hospitals couldn't magically support twice as many residents while maintaining quality.

5. Doctor Shortage: As the others have responded, there is definitely not consensus within the medical community that we have a "doctor shortage". The largest issue is that of maldistribution - both geographically (i.e. we need more doctors in rural areas and geographically undesirable parts of the country) and specialty-wise (i.e. we need more PCPs and fewer sub specialists). The ways to fix this are, to most med students and pre-meds, undesirable. A couple examples of what these initiatives might look like:
-Put caps on specialty training spots, or pull funding from residencies like derm and plastics and divert that money into additional primary care residency slots. (i.e. force grads into PCP residency)
-Mandated PCP service of some duration of time upon graduation (similar to a GMO tour for the military)

We already try to incentivize primary care in underserved areas (loan repayment programs), and guess what - people still don't want to do it.

There's really no magic fix. If we want to address the potential of a PCP shortage/maldistribution, we have some tough and not fun choices to make. Continued expansion of mid-level providers, defunding other residencies in favor of primary care, mandated/forced service, etc. Unless you can find a way to better incentivize people to go into primary care than the existing debt repayment programs which don't seem to be working. You have a problem of motivation - the carrot doesn't seem to be working, so next up is the stick.

 

[deleted480308]

Do you think Corinthian College grads would fair as well as the average grad from the average college in medical school interviews? Would they have as many experiences to draw from? Also, what are we arguing about? lol

I think to imply that having access to intramural volleyball, some frat parties and an on campus jamba juice makes someone more qualified than a working student is presumptuous. Implying that someone who went to a "real" school has an edge over someone so bad at investigating things that they actually enrolled at corintian college is a much better thought process.

I have friends all the time signing up for online degrees at UoPhoenix who look at me with a blank stare when I tell them that public universities all over the state have online programs for 1/3 of the cost.....people just don't look into things

 

[Gibbward]

Since when is it about revenue? It's about education. The college experience is just as, if not more important than what you learn in the classroom. Seems like you don't understand that there is a world outside of medicine (and thankfully so). People who think like this are exactly who they are trying to keep out of medical schools.

Colleges are for the most part about revenue though. Colleges need to establish a healthy and fun environment, simply because that's going to draw in the students and their tuition money. That's why a school would pay to build a new sports complex over upgrading the school library. It's the sexy thing to do, and it's going to generate more profit in the long run.

 

[Mad Jack]

Undergrad education has long been about revenue. There's a reason why more funding goes to men's football than swimming and why college instructors are asked to look the other way in regards to athletes class attendance and failing test scores.

Not that I would know anything about that.

My school actually had a male recruiting problem (I think the school us nearly 70% female) that they attempted to improve by adding two sports teams and building a stadium. Not only has it increased male enrollment, but it has substantially increased enrollment, as evidenced by my inability to find parking.

 

[PreciousHamburgers]

I think to imply that having access to intramural volleyball, some frat parties and an on campus jamba juice makes someone more qualified than a working student is presumptuous. Implying that someone who went to a "real" school has an edge over someone so bad at investigating things that they actually enrolled at corintian college is a much better thought process.

I have friends all the time signing up for online degrees at UoPhoenix who look at me with a blank stare when I tell them that public universities all over the state have online programs for 1/3 of the cost.....people just don't look into things

Why did you bring up working students? I never said anything about that. I worked through college. I don't think it is presumptuous to think that someone with easier access to character-building activities will, on average, be more prepared after college. Things like sports, organized and established volunteer opportunities, mentoring programs, etc are proven to be valuable, it is not presumptuous. It would be presumptuous if I had indeed set up the exaggerated comparison you invented, though.

 

[deleted480308]

Why did you bring up working students? I never said anything about that. I worked through college. I don't think it is presumptuous to think that someone with easier access to character-building activities will, on average, be more prepared after college. Things like sports, organized and established volunteer opportunities, mentoring programs, etc are proven to be valuable, it is not presumptuous. It would be presumptuous if I had indeed set up the exaggerated comparison you invented, though.

I get it, I was the guy going to my local university on nights and weekends (much like you describe for yourself) but I wasn't remotely the norm there. The "I'm working now, but going back to school to try and improve my life" is actually the norm for these online pits they call schools......it just so happens that they attract people who don't investigate well up front

 

[Winged Scapula]

Do you think Corinthian College grads would fair as well as the average grad from the average college in medical school interviews? Would they have as many experiences to draw from? Also, what are we arguing about? lol

Disagreeing with you does not equate arguing in my book.

While I would love to believe the lofty ideal that education without monetary influence, that's just not my experience.

As sb47 points out, students from Corinthian may fare less well because of the impression that they were unable to thoroughly investigate their educational options.

While admittedly it may sound pompous and elitist I also think we have to admit that many such students will also be less erudite and polished than their colleagues from traditional undergraduate universities. This means that making that all important first impression can be more difficult, but fortunately we have faculty who are able to see past such things and look for other important qualifiers.

 

[PreciousHamburgers]

Disagreeing with you does not equate arguing in my book.

While I would love to believe the lofty ideal that education without monetary influence, that's just not my experience.

As sb47 points out, students from Corinthian may fare less well because of the impression that they were unable to thoroughly investigate their educational options.

While admittedly it may sound pompous and elitist I also think we have to admit that many such students will also be less erudite and polished than their colleagues from traditional undergraduate universities. This means that making that all important first impression can be more difficult, but fortunately we have faculty who are able to see past such things and look for other important qualifiers.

I do not believe education is not influenced by money, at all.

All I am saying is that I would not be the same person I am today if it were not for the athletics, mentoring, liberal arts education, and other EC's I had access to at a traditional college. I learned how to behave/speak professionally and how to network. I became more 'erudite' than I would have been given my background. I would not have learned these things if I only took my classes and gotten my degree.

 

[hoihaie]

Ucsd hasn't had a football team and grads seem to be fairing well 😛

 

[lmn]

Lol wow the OP is a self-entitled prick. You really think you are SOOOOO much more important than any other department? You think we should just shift all our money to making more doctors and that would be a perfect society? You really need to grow up and gain perspective.

Also you clearly know nothing about the physician "shortage" if all you are talking about is make more med schools.

 

[mehc012]

-Mandated PCP service of some duration of time upon graduation (similar to a GMO tour for the military)

I'd be all for that...I would love to participate in some of these programs, but I'm honestly worried that doing so would affect my career down the line. I'm perfectly willing to give 5yrs of my life to rural healthcare, but not if it means I'd be stuck as a PCP for my entire career, noooo thank you. And not if doing so means I won't be considered for strong residencies/fellowships down the road, either.

Right now, going PCP is a permanent decision. If I could, say, retire to a rural PCP position when I wanted a change of pace, that'd be a different story. But if I want a career as a surgeon, that effectively bars me from doing any such thing.

 

[DokterMom]

I do not believe education is not influenced by money, at all.

All I am saying is that I would not be the same person I am today if it were not for the athletics, mentoring, liberal arts education, and other EC's I had access to at a traditional college. I learned how to behave/speak professionally and how to network. I became more 'erudite' than I would have been given my background. I would not have learned these things if I only took my classes and gotten my degree.

Your second statement, which I agree with, is completely inconsistent with your first -- Typo?

 

[mehc012]

Your second statement, which I agree with, is completely inconsistent with your first -- Typo?

Double negative, methinks 😉

I also had to read it a few times to clarify.

 

[DokterMom]

Double negative, methinks 😉

I also had to read it a few times to clarify.

You're right - I misread the double-negative.

 

[lmn]

OP please also tell us how just pumping out more MD graduates would actually solve the primary care shortage instead of mostly just creating even more of an abundance of specialists in a few saturated, relatively small amount of popular geographical locations.

 

[Law2Doc]

OP please also tell us how just pumping out more MD graduates would actually solve the primary care shortage instead of mostly just creating even more of an abundance of specialists in a few saturated, relatively small amount of popular geographical locations.

My suspicious take on his post is it's less about actually solving a systemic problem and more about wishing his own path was less uphill.

 

[sazerac]

The issue we have is really more of a doctor distribution problem than a doctor shortage one; we have plenty of physicians, it's just that we have too many specialists in saturated locations and not enough primary care physicians in rural / more undesirable areas.

I come from rural USA. We lack specialists too. The distribution problem is geographical, and not specialty vs PCP.

 

[mehc012]

I come from rural USA. We lack specialists too. The distribution problem is geographical, and not specialty vs PCP.

Is the case load large enough to actually support a specialist? Actually wondering...seems as if it would be hard to make a living on a trickle of cases, even if all of those patients sorely needed the specialist.

 

[Goro]

To follow up on my learned colleague's comments, just look at the tiny, poor state of West Virginia, which has three medical school (2 MD, 1 DO). Their emphasis is to train Primary care physicians who will serve WV.

Do you know where the vast bulk of their grads end up practicing?

Morgantown and Charleston, the two biggest cities in the states. Doctors go where the money is, which is not necessarily where they're needed.


. Actually the medical world completely disagrees with this. There are plenty of doctors. The problem isn't one of volume, but distribution. Doctors all want to do derm or plastics in NYC or LA. Nobody wants to do OB in rural Montana. Graduating more physicians won't ever fix this problem, just worsen it.

 

[mehc012]

To follow up on my learned colleague's comments, just look at the tiny, poor state of West Virginia, which has three medical school (2 MD, 1 DO). Their emphasis is to train Primary care physicians who will serve WV.

Do you know where the vast bulk of their grads end up practicing?

Morgantown and Charleston, the two biggest cities in the states. Doctors go where the money is, which is not necessarily where they're needed.


. Actually the medical world completely disagrees with this. There are plenty of doctors. The problem isn't one of volume, but distribution. Doctors all want to do derm or plastics in NYC or LA. Nobody wants to do OB in rural Montana. Graduating more physicians won't ever fix this problem, just worsen it.

Make physician semi-retirement programs in the boonies. Sick of surgical hours? Debt was paid off years ago? Do some transition training and then run a 9-5 3d/wk in the middle of nowhere. Maybe subsidize the operating costs or get rid of residual debt or something to make it appealing. I wouldn't derail my career to go help with the shortage, or completely change my specialty of interest, but I could see retiring early to move to a remote place and be helpful. Sure, you get half-time work out of everyone, but a few half-time docs is better than zero full timers despite the enticements.

 

[mehc012]

Why would I do that when I could move to a desirable location like Phoenix and be @Winged Scapula 's surgical first assist with minimal overhead or malpractice coverage?

(Not a joke, FA jobs or doing exposures for spine are a very viable plan for a surgeon seeking semi-retirement)

Fair point. I suppose I see the rural locations as desirable (I'd love to live in the boonies) but the jobs...aren't. I guess my point is more that the current setup isn't working. They need to do something different to make these jobs desirable, or they're going to keep on having a distribution problem. Right now, in order to go rural, it seems as if that's got to be something you're comfortable making your actual career out of. To me, that's a HUGE barrier. I'd rather go get shot at for a few years, it's not as much of a career killer and it will get rid of your debt just as readily as going rural.

As clarification: I'm not advocating military service for anyone simply to pay debt. I'm simply pointing out that, as someone with career ambitions who wants to give back and could see themselves either in a rural setting or the military aside from debt issues, the military is more appealing. Considering the actual, physical, risks entailed by military service, I think that speaks volumes.

 

[deleted480308]

Fair point. I suppose I see the rural locations as desirable (I'd love to live in the boonies) but the jobs...aren't. I guess my point is more that the current setup isn't working. They need to do something different to make these jobs desirable, or they're going to keep on having a distribution problem. Right now, in order to go rural, it seems as if that's got to be something you're comfortable making your actual career out of. To me, that's a HUGE barrier. I'd rather go get shot at for a few years, it's not as much of a career killer and it will get rid of your debt just as readily as going rural.

As clarification: I'm not advocating military service for anyone simply to pay debt. I'm simply pointing out that, as someone with career ambitions who wants to give back and could see themselves either in a rural setting or the military aside from debt issues, the military is more appealing. Considering the actual, physical, risks entailed by military service, I think that speaks volumes.

I would propose that one of the mechanisms being set up by government under the guise of getting everyone care is making it worse. We put a bunch of people on the public dole in terms of health insurance in order get them all care. Then when we do that we make a huge portion of the population all pay the same amount of money in terms of provider reimbursement. So now if I'm one of the 50% of doctors willing to lose opportunity cost with these patients I can either do it somewhere with guaranteed volume or I can go out in middle of nowhere with no money to be made and no civilization to spend it in.....that does not appeal to most people (I love the country)

If the government is going to assume the goal of forcing distribution, they need to pay more in those areas

 

[Hyde]

The issue we have is really more of a doctor distribution problem than a doctor shortage one; we have plenty of physicians, it's just that we have too many specialists in saturated locations and not enough primary care physicians in rural / more undesirable areas.

Walgreens and Insurers have an "interesting" solution ( virtual doctor visits).

http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2015-06-10-09-01-22

 

[WingedOx]

desirable location like Phoenix

hmmmm

 

[mehc012]

Military too in certain areas and specialties. Tele-consult psych is getting popular in the real world.

We'll see what happens first time we have a missed postop infection or DVT because we didn't "lay hands" on the patient.

Our ER recently set up a teleneurology program that seems to be going alright, they basically just do the initial stroke workup so the neurologists don't have to come in at night.

 

[mehc012]

The central tension is that a physical exam is considered standard of care in nearly every patient encounter. Some places have tried to use mid-levels or nurses to do the physical exam with physician observing, but that has limits.

I like the tele-consult idea, but I also worry it will turn into lawyer bonanza where every delay in diagnosis or unexpected outcome is blamed on inadequate evaluation. And who knows, that may end up being true.

After all, the neurologist cannot use their fancy Queens hammer over Skype... If they start relying on the ER doctors assessment, they'll either have to admit that a stethoscope is good enough to test reflexes, or that their information was subpar when deciding treatment! Tough choice, that one!

 

[mehc012]

This may not matter in the case of an acute stroke, where imaging is the central concern. I don't really know.

My field has been talking more and more about using tele-medicine for post-op appointments. This is based on the assumption that the vast majority of post-op patients are doing fine, and don't need anything. You can look at their wound, you can watch them demonstrate their motion, you can observe some elements of muscle strength.

But you can't do a proper neurovascular exam. And you can't feel for fluctuence under the wound. And you can't feel for warmth.

Basically we're going to rely on an incomplete history and exam to determine whether the patient actually needs to see a person. This strikes me as a high risk proposition. But maybe it will be fine.

I was largely joking, but yes, I do see your point. At my hospital it is used only for Neuro, and only for overnight admits (a real live doc sees them in the AM). In that case, the primary exam is the ER physicians, with additional non-touch tests done via videoconference. That and imaging get you a long way in neurology! And again, it's only for a few hours.