Democracy Project – July 31, 2007

Is there a doctor in the house?

What happens if “universal healthcare” is decreed, and there’s no doctor in the house? What happens when the proponents of “universal healthcare” also castigate the best and brightest who choose to endure the rigors of medical training by reducing their financial incentive?

A report in the Wall Street Journal says that the Massachusetts experiment in “universal healthcare” may founder on the lack of enough primary care physicians:

State officials have acknowledged the problem. “Health-care coverage without access is meaningless,” Gov. Deval Patrick said in March.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

A principal reason: too little money for too much work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colo. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.

At the same time, the workweek for primary-care doctors has lengthened, and they are seeing more patients. The advent of managed care in the mid-1990s added to the burden as insurance companies called on primary-care doctors to serve as gatekeepers for their patients’ referrals to specialty medicine.An op-ed in USA Today, by an immigration lawyer, delves further, with attention to the British experience with terrorist doctors. Strict screening is the key.

Why haven’t we heard any links of these foreign physicians to terrorism in the USA? Most likely because of the extensive background checks that all skilled workers, including doctors, undergo before being admitted. British security clearances for skilled workers are not as extensive, and the process is under review.

It might help to know some basic data:
* Physicians in the USA: 794,893.
* Foreign graduate doctors in the USA: 185,234 (from 127 countries).
* Percentage of doctors in U.S. training programs who are foreigners: 24%.

This is not a new phenomenon. Foreign physicians have made up about this percentage of our doctor population for years. A sizable portion work in medically underserved communities and small towns. This at a time when a shortage of doctors in the USA is expected to grow to as much as 200,000 by 2020.

Why is this shortage happening?

First, the USA has opened almost no new medical schools in the past 25 years. So you have a physician population that has remained flat serving a U.S. population that is expected to grow by 25% between 2000 and 2025.

Major demographic changes in the physician population also must be considered. Nearly one-third of doctors are older than 55, with more choosing early retirement. Fifty percent of all medical school graduates are now women. That is affecting both the total hours worked each year as well as the number of specialists. Family demands are causing many women to reduce their hours or to leave the profession when they have children. Some women doctors avoid fields with difficult call hours, such as anesthesiology and radiology.

Then there are our own demographic changes. The number of Americans older than 65 will increase to 54 million by 2020. As we age, our need for medical care increases.

Finally, as more treatment options are available and new technology is developed, Americans are more likely to seek out the services of a physician or specialist.

Reprinted with permission of Bruce N. Kesler, ChFC REBC RHU CLU

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