Healthcare "Reform" creates doctor shortage

[WinterBorn]

That's a really good point. Unfortunately with providing more free care and not paying directly for it, people will just demand the best.


The healthcare "reform" passed just takes us further from that.

Actually, passing this bill did nothing of the sort.

Ever try demanding anything from the gov't?

 

[Mott the Hoople]

doctors are limiting the supply then crying, whambulance let them eat cake with the racist tea baggers.

Exactly. State Boards, the AMA and Univiersities have been in collusion for years to keep the supply of phsyicians, particularly primary portal to health care physicians in low supply in order to keep fee schedules artificially high and to make the cost of a medical education insanely priced. It cost about 10 times as much to obtain a medical degree in this nation as in any other nation. Dano is just another uninformed tea bagger.

 

[Mott the Hoople]

We need to help qualified people get through med school.

Its as simple as that.

I would agree to a $100,000/year salary if the Government would pay for Medical school. THat's what most nations are doing to create the needed supply on internest, family physicians and other primary care physicians which are in very low supply but high demand. Particularly in underserived rural areas. The goverment pays for your medical education and you work for them for X number of years at the salary they specify. Nothing wrong with that.

 

[Topspin]

I carpooled with the son of a dr who had a 3.88 gpa, he's a dr now but had to wait two years to get into med school. Anybody who tells me dean's list is not good enough to get into med school can save that air for their death bed.

 

[Mott the Hoople]

I have what amounts to universal health care. I've had it all my life. The incentive to "limit my use" is in the hassle of having to go to the doctor in the first place. Of having to wait a long time for appointments or wait an hour or two past my appointment time when I'm there...which I have to do most of the time whether I am using my universal health care hospital or if I go to a public hospital and use the insurance I pay for. When you have something like a sinus infection and have to wait three weeks for an appointment in either place...it doesn't do much good. I don't know if flooding the hospitals with appointments because Johnny's got a cold will take place or not. I know there is a shorage of doctors now...and the shortage is likely to continue but I'm not sure that is a reason I don't like the health care bill.

The health care bill has absolutely nothing to do with that. The problem is we have a nearly crises level shortage of primary care physicians. Since the most money in health care is to be made in specialization most medical students go into specialized fields to maximize their income. Nothing wrong with that, per se. The problem is, is that these are not health care phsyicians. These are physicians that specialize in disease or trauma therapy or surgical procedures. They don't practice primary health care, which is where the real demand is.

So we now have an artificially low supply of primary care physicians and thus lines and appointments and long waits. The current health care reform bill has nothing, I repeat, nothing to do with that. It's about rerforming health care finance.

The real issue is how for profit health care institutions have a vested interest in the higher profit specialized medical modalities and not primary care. It's a big reason why we have such fantastic medical technology but such low over all health out comes.

Were great at performing triple bypass operations but lousy at treaching patients how to prevent coronary heart disease. This needs to change and we need to have more of a focus on primary health care in this nation.

 

[Mott the Hoople]

I've seen you say this before and I don't think I agree. I want the standards high. I don't really want a doctor who made it through Med. School with a "D" treating my kid. I think the prices are unfairly high due to supply/demand and high (and getting higher) malpractice insurance.

I think your worries are unfounded. The requirements for acceptance into medical school are exceedingly high and will remain so. What cause most medical students to persue other fields or professions (and I'm a good example of that) is the outrageous cost for a medical education which has been kept artificially high. Many qualified people simply do not go into the field as they simply cannot afford the education. There are many emininently qualified students who would agree to go into primary care fields if the goverment would pick up the tab for their education and I can assure you these are not frisbee chucking majors.

Lets not forget to that getting into Med school is one thing, staying there is another. You still have to maintain a high GPA in an extremelly demanding academic curriculum. Trust me when I say, if you can get through medical school no one gives a shit what your GPA is. Just meeting the basic standards for excellence is good enough. They don't graduate you from Med school if you can't demonstrate your competence and GPA be damned.

 

[Mott the Hoople]

The cutoff for failure in Med School on any exam or test is 80%. It isn't unusual, though, for grades to be curved in order to balance out poor scores on extremely difficult tests, and some test questions may be examined by a board if complaints suggest that they are too vague or tricky to be answered correctly. If so, they may be removed from the test and tests then are regraded.

You know what they say, though. What do they call the person who graduated in last place in his/her Med. Sch. class? "Doctor". I don't want that person treating me.

Why? Why wouldn't you? I've been in the Med School environment and it was the folks with the high GPA's who ussually made the worst physicians in the real world. A high GPA doesn't translate necessarily into being a good Doctor. I knew lots of high performing Med school student with high GPA who sucked as doctors cause they lack the empathy, the communication skills, the eye hand cooridination or just couldn't put the overall picture together in practice. Where as lots of C and B students from Med Schools go out into practice and are the ones to earn the reputations as being outstanding clinicians.

In medical practice credentials are nice but in reality it's your demonstrated ability and competency that counts and a GPA from school is not a complete measure of that. I'd have no problem going to a Doctor who had the lowest GPA in their class. Particularly if that Doctor has demonstrated brilliance in the real world.

 

[Mott the Hoople]

I carpooled with the son of a dr who had a 3.88 gpa, he's a dr now but had to wait two years to get into med school. Anybody who tells me dean's list is not good enough to get into med school can save that air for their death bed.

GPA and MCAT scores aren't everything there is to getting into med school. It's also about seats available and don't forget that legacy students get first choice in general. In quite a few medical schools, in some years, after their legacy obligations are met, there's not a whole lot of open seats available.

 

[Thorn]

I carpooled with the son of a dr who had a 3.88 gpa, he's a dr now but had to wait two years to get into med school. Anybody who tells me dean's list is not good enough to get into med school can save that air for their death bed.

It is one of those "necessary but not sufficient" items. Letters of reference, volunteer activities, GPA, MCAT scores, even extracurricular interests, are all considered, as is the letter that accompanies the application. The latter, though, often are seemingly cut from the same cloth "I want to help humanity" type stuff. Each of these is necessary, but none alone is sufficient to get an applicant into med. school. The competition is so stiff that most have a 4.0 GPA and a score of 28 at the very least on the MCAT.

Mott is right about the insane costs of a medical school education. Remember that article a couple of months ago about the family practice physician who had racked up about a quarter million in debt for her med school education, then stupidly let it slide during her residency and now owes around $550K? Not long after I joined the board years ago, I wrote about the relative costs, without the numbers, of a med. school education in Canada, specifically Ontario. Granted, the salaries when compared to here are not as high, but it's possible to get through with minimal, or even no debt. The selection process is more rigorous, but that tends to produce a class that really wants to practice medicine, with less eye on the huge salaries that may be attractive in more ways than to repay the costs of the education.

 

[Topspin]

It is one of those "necessary but not sufficient" items. Letters of reference, volunteer activities, GPA, MCAT scores, even extracurricular interests, are all considered, as is the letter that accompanies the application. The latter, though, often are seemingly cut from the same cloth "I want to help humanity" type stuff. Each of these is necessary, but none alone is sufficient to get an applicant into med. school. The competition is so stiff that most have a 4.0 GPA and a score of 28 at the very least on the MCAT.

Mott is right about the insane costs of a medical school education. Remember that article a couple of months ago about the family practice physician who had racked up about a quarter million in debt for her med school education, then stupidly let it slide during her residency and now owes around $550K? Not long after I joined the board years ago, I wrote about the relative costs, without the numbers, of a med. school education in Canada, specifically Ontario. Granted, the salaries when compared to here are not as high, but it's possible to get through with minimal, or even no debt. The selection process is more rigorous, but that tends to produce a class that really wants to practice medicine, with less eye on the huge salaries that may be attractive in more ways than to repay the costs of the education.

thanks for arguing my point for me, it's too hard to get in.
I agree with the poster that said $100,000 starting salary, education completly paid for.

 

[Mott the Hoople]

It is one of those "necessary but not sufficient" items. Letters of reference, volunteer activities, GPA, MCAT scores, even extracurricular interests, are all considered, as is the letter that accompanies the application. The latter, though, often are seemingly cut from the same cloth "I want to help humanity" type stuff. Each of these is necessary, but none alone is sufficient to get an applicant into med. school. The competition is so stiff that most have a 4.0 GPA and a score of 28 at the very least on the MCAT.

Mott is right about the insane costs of a medical school education. Remember that article a couple of months ago about the family practice physician who had racked up about a quarter million in debt for her med school education, then stupidly let it slide during her residency and now owes around $550K? Not long after I joined the board years ago, I wrote about the relative costs, without the numbers, of a med. school education in Canada, specifically Ontario. Granted, the salaries when compared to here are not as high, but it's possible to get through with minimal, or even no debt. The selection process is more rigorous, but that tends to produce a class that really wants to practice medicine, with less eye on the huge salaries that may be attractive in more ways than to repay the costs of the education.

I had a 3.0 GPA but I got a 36 on the MCAT.....and I was only a Junior.

 

[Mott the Hoople]

thanks for arguing my point for me, it's too hard to get in.
I agree with the poster that said $100,000 starting salary, education completly paid for.

That was me.

A number of nations do that as part of cost controls on salaries. They pay for the tuition of nurses, technicians and Phsycians who are then obligated to work at a fixed rate for x number of years. Since their salaries are still well above median salaries, there's no problem finding qualified persons to take that deal. Like I said, if someone had offered me that deal when I was in grad school I would have jumped on it with both feet.

 

[TuTu Monroe]

A lot of what we see doctors for could be handled by nurses or other people (like nurse practioners).

That would free up the Dr for more patients who actually need to see them.

We already have that here. I have mixed feelings about it.

 

[Topspin]

We already have that here. I have mixed feelings about it.

I'm with you, I'm ok with them doing colds and spain's etc. Once it requires a perscription leave that to the dr.

 

[Thorn]

Why? Why wouldn't you? I've been in the Med School environment and it was the folks with the high GPA's who ussually made the worst physicians in the real world. A high GPA doesn't translate necessarily into being a good Doctor. I knew lots of high performing Med school student with high GPA who sucked as doctors cause they lack the empathy, the communication skills, the eye hand cooridination or just couldn't put the overall picture together in practice. Where as lots of C and B students from Med Schools go out into practice and are the ones to earn the reputations as being outstanding clinicians.

In medical practice credentials are nice but in reality it's your demonstrated ability and competency that counts and a GPA from school is not a complete measure of that. I'd have no problem going to a Doctor who had the lowest GPA in their class. Particularly if that Doctor has demonstrated brilliance in the real world.

You may have a point with respect to some, but not all, of those high-performing students. Remember, I work in a Med. School and my husband is involved in course design and teaching, and is on the promotions committee here as well. Med. students don't pass with a C grade. Unlike Ph.D. students, who are kicked out if they get a C in a course, a Med. student may retake a failed course with permission from the committee. They still have to get a minimum 80% for the course. I may be obsessing on a handful of students I know personally or know about, but some who actually managed to squeak through are not among those I'd trust with my health.

That may change now, as the approach in Med. School is different. Students are taught the basic information they'll need, but more importantly learn how to integrate that information. The databases that are available now through the Internet make the grinding memorization less important as access to the information is readily available and knowledge of how to read and understand it is also taught. The emphasis now is on a problem solving approach, using the basic knowledge gained in each block.

To agree with your point, though, my postgraduate mentor wouldn't consider for the lab a student with a perfect GPA unless that person had demonstrated a high level of creativity, insight and work ethic far beyond what can be learned by rote in the classroom. Acceptance into a Master's or Ph.D. program actually required research experience at the undergraduate level, preferably with at least one publication, as well as an Honors undergrad degree, which included not only keeping your grades above a certain level but also an extra year of study and research. Grades were important, but only as a part of the larger picture and a perfect GPA wasn't necessarily an advantage.

 

[Thorn]

I'm with you, I'm ok with them doing colds and spain's etc. Once it requires a perscription leave that to the dr.

I believe that Nurse Practitioners have a limited authority to write prescriptions.

 

[KingCondanomation]

The health care bill has absolutely nothing to do with that. The problem is we have a nearly crises level shortage of primary care physicians. Since the most money in health care is to be made in specialization most medical students go into specialized fields to maximize their income. Nothing wrong with that, per se. The problem is, is that these are not health care phsyicians. These are physicians that specialize in disease or trauma therapy or surgical procedures. They don't practice primary health care, which is where the real demand is.

So we now have an artificially low supply of primary care physicians and thus lines and appointments and long waits. The current health care reform bill has nothing, I repeat, nothing to do with that. It's about rerforming health care finance.

The real issue is how for profit health care institutions have a vested interest in the higher profit specialized medical modalities and not primary care. It's a big reason why we have such fantastic medical technology but such low over all health out comes.

Were great at performing triple bypass operations but lousy at treaching patients how to prevent coronary heart disease. This needs to change and we need to have more of a focus on primary health care in this nation.

This is flat out not true. Find any economist on the planet, even a leftwing hack like Krugman, who will come out and say that offering more free care not paid by the user will not result in higher demand and thus a shortage.
You will have 30million suddenly seeking care, and a shortage already of primary care MDs.

In fact it has ALREADY happened in Mass with their similar bill of forced insurance coverage and gov paying for those who qualify:
http://www.npr.org/templates/story/story.php?storyId=97620520

 

[Topspin]

I don't know King Krugman seems so left that he's barely resembles other economist.

 

[WinterBorn]

I believe that Nurse Practitioners have a limited authority to write prescriptions.

I think that is the major limitation, although there are surely others.

But I think there are plenty of situations in which a nurse practioner would be sufficient. Better an NP than a Dr who is rushed and stretched too thin.

There are also ways in which certain prescriptions can be requested by the NP and approved by the Dr.

 

[Mott the Hoople]

You may have a point with respect to some, but not all, of those high-performing students. Remember, I work in a Med. School and my husband is involved in course design and teaching, and is on the promotions committee here as well. Med. students don't pass with a C grade. Unlike Ph.D. students, who are kicked out if they get a C in a course, a Med. student may retake a failed course with permission from the committee. They still have to get a minimum 80% for the course. I may be obsessing on a handful of students I know personally or know about, but some who actually managed to squeak through are not among those I'd trust with my health.

That may change now, as the approach in Med. School is different. Students are taught the basic information they'll need, but more importantly learn how to integrate that information. The databases that are available now through the Internet make the grinding memorization less important as access to the information is readily available and knowledge of how to read and understand it is also taught. The emphasis now is on a problem solving approach, using the basic knowledge gained in each block.

To agree with your point, though, my postgraduate mentor wouldn't consider for the lab a student with a perfect GPA unless that person had demonstrated a high level of creativity, insight and work ethic far beyond what can be learned by rote in the classroom. Acceptance into a Master's or Ph.D. program actually required research experience at the undergraduate level, preferably with at least one publication, as well as an Honors undergrad degree, which included not only keeping your grades above a certain level but also an extra year of study and research. Grades were important, but only as a part of the larger picture and a perfect GPA wasn't necessarily an advantage.

Well like I said, I been around a lot of Doctors and a high performance in school doesn't always translate to being the best physician in practice. To use another analogy, if you looked at all the GPA's from Harvard's MBA class of 1985 I bet you'll find that a lot of the top business men from that year did not have the best grades in their class. My point being, it's a big jump from studying medicine to practicing medicine and good grades won't help you if you have an inability to communicate or empathise, particularly if you're in private practice.

I'm not saying that those at the bottom of the class always make the best doctors, that would be stupid but the reverse is true too. I've seen a lot of people at the top who stumbled on other issues when it came time to practice professionally. Though good grades still are a strong indicator of success.