Archive for the ‘Doctors & Physicians’ Category

One way to alleviate the shortage of doctors…

June 27, 2017

Grant med school grads provisional licenses.

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Very interesting idea reported by the Heritage Foundation

It widely accepted that the U.S. has a current shortage of doctors that is expected to balloon as the demand increases (aging population, expanded Medicaid, etc.).

Current estimates put the 2030 shortage between 40,000 and 105,000.

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Each year, US med schools crank out about 18,000 medical degrees. Source

Dictated by the AMA, before getting licensed, these grads need to go through formal residency programs at teaching hospitals.

Here’s the rub.

The residency programs are largely government funded, and there are spending caps.

Spending caps translate to enrollment caps.

So, each year, about 5,000 of the med school grads — more than 25%) — don’t get a residency slot.

No residency, no license.

Reportedly, these non-residentially certified med school grads either land in non-patient treating medical jobs (think “pharma”) or leave healthcare all together.

The usual response: just throw more tax dollars at the problem.

But, there are other options…

Addressing the problem, a few states have implemented a program that Heritage is now touting: provisional licenses.

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Surviving a post-med school residency …

August 20, 2014

We’ve been spending a lot of time at Georgetown Hospital recently.

In the process, we’ve developed a deep respect for some of the key cogs in the system: nurses, nurse practitioners and doctor-residents.

In casual conversation, our surgeon mentioned how she had managed to “survive her surgical residency”.

That got me wondering, about the life of a resident.

 

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Here’s what I found …

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What happens when you cut doctors’ reimbursement rates?

April 24, 2014

Here’s a shocker …

They spend less time seeing patients.

Medscape does an annual hours and pay survey.

For 2013, the Medscape survey said that the average doctor was face-to-face with patients about 41 hours …. with about 2/3s of them in the 40 to 50 hours cluster.

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How does the 41 hours compare to historical rates?

 

 

According to Medscape:

A 2010 study in JAMA found that after no significant change between 1977 and 1997 in the hours per week that physicians spend with patients’

Patient hours decreased steadily from 54.6 to 51.0 between 1997 and 2007.

The study authors attributed the decrease to a parallel 25% inflation-adjusted decline in fees between 1996 and 2006.

Shocker, right? 54.6 to 51 to 41 …

Pay somebody less and they’re less incentivized to bust their humps.

Think about that each time you hear about the Feds and insurance companies ratchet down the reimbursement rates to “fix” the healthcare system,

I’m betting the under on that one.

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“Can’t force doctors to take ObamaCare patients”… oh really, O’Reilly?

December 11, 2013

According to the head of California’s  largest medical association  “seven out of every 10 physicians in California are rebelling against the state’s ObamaCare health insurance exchange and won’t participate”. Source

Why?

Simple economics: the reimbursement rates are too low.

ObamaCare Exchange reimbursement levels appear to mirror Medicare & Medicaid rates.

And, for example, Medicaid only reimburses doctors 72 cents out of each dollar of costs.

You can’t make it up in volume.

 

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Similarly, some high profile hospitals – e.g. Sloan-Kettering, Cedars Sinai – are opting out of the Exchange programs.

Why?

Reimbursements rates are too low.

Most conservative pundits are saying that the shrinking doctor & hospital networks will force ObamaCare to its knees … since people will revolt when they can’t use “their” doctors or the best hospitals.

Further, O’Reilly, et. al., have been saying “… and there’s nothing Obama can do about it.”

I beg to differ Mr. O’Reilly …

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Your doctor will see you … in a couple of months.

August 2, 2012

Fairly balanced piece in the NY Times last Sunday re: the impacts of ObamaCare

Punch line: In 2015 the country will have 62,900 fewer doctors than needed … that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care.

The problem, in a nutshell …

  • There is a shortage of every kind of doctor, except for plastic surgeons and dermatologists
  • Primary care doctors make about $200,000 a year. Specialists often make twice as much.
  • ObamaCare adds about 30,000 people to insurance rolls … the majority via Medicaid
  • Fewer than half of primary care clinicians are accepting new Medicaid patients
  • Medicare will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.
  • “Older Americans require significantly more health care,”
  • And about a third of the country’s doctors are 55 or older, and nearing retirement.
  • Younger doctors are on average working fewer hours than their predecessors.
  • It typically takes a decade to train a doctor.
  • Medical schools are at capacity and Federal training subsidies have been cut.

 

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While ObamaCare mandates broader insurance coverage, it does little to fundamentally restructure the healthcare delivery … save for government administered rationing.

Part of real answer: more doctors (new and retained), more walk-in clinics (public & private), and more authority to RNs and PAs.

Note: the Times failed to mention that the CBO’s current estimate for ObamaCare’s costs has tripled since the law was passed. 

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