Nov 2, 2010
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As the title states, how much longer until our medical system starts to resemble the surplus and economics of Europe. For our sake, I hope not within the next 20 years.

The economic similarities are already beginning to shape in my opinion. With the seemingly significant spike in admissions projected over the next years, what will happen when the Baby Boomers go bye bye. I predict a massive excess of primary care physicians (with caps on residency placements such as Derm., Plastics, Neuro, etc. staying in place).



Abstract

In 1999, there are 336,000 medical doctors in Italy, as compared to 86,000 in 1964. The present-day ratio is 583 physicians per 100,000 population. Italy has probably the highest level of medical staffing in the world. The medical school intake has been controlled since the early 90's and the annual number of new graduates has recently decreased. However, the number of active doctors has not yet been stabilized. After the recent statistics, nearly 39,000 medical doctors cannot find a job in the various medical fields, i.e. more than 11% of the profession. Furthermore, a great number of doctors have not a full-time job. Surprisingly, the physician/population ratio is lower in the northern provinces where the per capita GDP is much higher than in the South. The feature evidences the importance of non-economic factors in shaping the geographic distribution of health workforce.

PMID: 12050938 [PubMed - indexed for MEDLINE]
 

Ursa

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Kevin Baker

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Why would there be an excess of PCPs? There currently is a shortage and a lot of docs will be retiring and only in the past decade have medical schools been significantly expanding while new ones have been opening. We currently have about half the amt of doctors per 1,000 that Italy has and we've been importing a lot of foreign doctors, while residency spots are staying stagnant. So, with a growing population, the retirement of many doctors, residencies remaining stagnant, lots of docs being imported due to the shortage, and schools just starting to increase enrollment, I don't see a shortage anytime soon. All I see are a lot of IMGs being replaced by domestically trained docs.
 
OP
S
Nov 2, 2010
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Why would there be an excess of PCPs? There currently is a shortage and a lot of docs will be retiring and only in the past decade have medical schools been significantly expanding while new ones have been opening. We currently have about half the amt of doctors per 1,000 that Italy has and we've been importing a lot of foreign doctors, while residency spots are staying stagnant. So, with a growing population, the retirement of many doctors, residencies remaining stagnant, lots of docs being imported due to the shortage, and schools just starting to increase enrollment, I don't see a shortage anytime soon. All I see are a lot of IMGs being replaced by domestically trained docs.

I agree with you 100%, in the short run there will not be any excess of PCPs, enhancing US medical school enrollment will only act to take over PCP spots going to IMGs.

We do have a shortage now, but won't primary care residencies just up their spots in coming years to take on increasing numbers of US and IMGs to meet demand. This is where our problem is and by increasing output we can solve the problem now. That is what happened in some Eurpean countries.

Specialties in my opinion will never get hit hard because they limit residency spots, but I feel that primary care residencies are at more of a liberty to up their eligible spots to meet demand. When the demand ceases they won't stop taking in more and more students so the surplus will continue.
 

Kevin Baker

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I agree with you 100%, in the short run there will not be any excess of PCPs, enhancing US medical school enrollment will only act to take over PCP spots going to IMGs.

We do have a shortage now, but won't primary care residencies just up their spots in coming years to take on increasing numbers of US and IMGs to meet demand. This is where our problem is and by increasing output we can solve the problem now. That is what happened in some Eurpean countries.

Specialties in my opinion will never get hit hard because they limit residency spots, but I feel that primary care residencies are at more of a liberty to up their eligible spots to meet demand. When the demand ceases they won't stop taking in more and more students so the surplus will continue.
The way I understand things work now is there are a set amount of residencies for each specialty and the total number doesn't generally change. There is much more demand for the specialty spots, so those fill, while many of the PCP spots go unfilled. The unfilled spots are often then taken by IMGs, in the scramble, or just left unfilled. So, as the supply of physicians slowly inches up, they'll simply nudge out the IMGs. But we currenly import so many IMGs (27% or so of all residents), that there won't be an effect on the number of total PCPs. The PCPs will simply increasingly be domestically trained. If schools want to up enrollment by more than 27%, then we might have problems, but I don't see this happening.
 

Dr Oops

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paul411

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Italy (1999) 583 doctors / 100,000 people = 172 people per doctor (ITA)
USA (2009) 307,006,550 people / 1,078,134 physicians = 285 people per doctor (USA)

Based on this, we need a 70% increase in physicians in the US (750,000) to reach the Italian levels (1999) that led to physician unemployment. Since the population growth rate of the US exceeds the physicians growth rate (I think; didn't look it up), we're pretty far away from such over-saturation of doctors here.
 
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This isn't related to your actual argument, but don't confuse Italy with the whole of Europe. That's all I gotta say.