A Doctor Shortage Near You

Sometimes I am amazed at the ignorance of the media.  The NYT just put out an article entitled “Doctor shortage likely to worsen with health care law“.   You think?  I have and others have been saying that for years.  The ACA (Affordable Healthcare Act) really kicks in in 2014.  The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed and that number will more than double by 2025.  And what we really need is primary care docs and there is little interest from students to go into this field.  Sure, the gov’t can talk a big game about provisions in the ACA to pay us more but the bottom line is that specialists get paid twice as much as us.  The law won’t do jack to fix that disparity.

I am seeing this issue right now in Virginia as hospitals and private groups are finding it difficult to hire family docs. Patients are coming to the urgent care where I work and just can’t find anyone to be their primary care physician.  It make me sad.  In Maine, where I left, my former employers were so cocky in their belief that I was easily replaceable.   Well, they couldn’t even find a locum tenen to help and it has been four months.  As for finding a permanent replacement, they have NO leads.   But it doesn’t even phase these professional administrators.   Heck, they don’t really do any work and don’t actually take care of patients so all they have to do is spin some bullshit.  In fact, I am convinced that they believe that a doctor should lead a team of LELTs (Less Experienced/Educated, Less Trained) practitioners and that will fix all the issues.  In fact, my former physician “leader” even came out and said that to one of my partners.   Why?  Because  he is a quitter and a sellout.  All these idiots know is to shuck and jive in order to survive.  They have no new ideas of their own so they follow what the government or insurance companies tell them to do.  This causes the need for more administrators to be hired to comply with these new rulings and the cycle continues.

So what are the answers?    We are so screwed up now that it won’t be easy.   Here is a section on this site where readers have been adding their ideas.   Please send me yours.   For now, I will reiterate some important recommendations.   I would start with paying primary care doctors more.  I would get some tort reform.   I would cut the amount of administrators in the medical world by over 80%.   I would destroy the present insurance model and go only to a catastrophic one and then let people pay cash for rest.   This would lead to prices coming down and better direct pay models to PCPs.   I would remove at least 30 to 40% off the Medicaid rolls just by culling the herd of those fraudulently abusing it.   And, I would add a monthly “Medicaid” fee to every one of their cell phone bills since they all seems to have one (with data and texting).    I know the last idea isn’t feasible but it sure was fun to say.

  11 comments for “A Doctor Shortage Near You

  1. Dr. Bill Ameen
    August 5, 2012 at 4:42 pm

    Hi again Dr. Doug,
    I’ve been thinking about applying to work at the MedExpress in Danville, VA, about 42 miles from me, when I retire from this hospital system’s urgent care next year! My associate left last November and they haven’t “found” anybody to help me yet, so I work 6-7 days a week (getting PA’s to double up to give me a day off). They had one lady doc who would have been perfect but they talked her into taking over a failing family practice that should have closed when the doctor left. Yes, there is a shortage of primary care, but moreso there is an oversupply of patients who can’t take care of themselves. You’re spot on, insurance ruined our specialty when they began to pay for office visits and medication. Patients still have no skin in the game except a $20 co-pay, so it makes sense to them to come to us for self-healing phenomena like poison ivy (and most other skin rashes), common colds, minor sprains, coughs, even “nerves” (that’s why wine is legal!). So urgent-care docs are inundated with people who would have been put off by their “primary care doctor” because they had to have an appointment and docs only want to work so hard (especially when they’re on salary!) and the national cost of healthcare just spirals out of control (not even thinking about the overwhelmed emergency rooms!). Maybe if appointment doctors would consider squeezing in just a few more patients who call in, it would de-burden the rest of the system. And more patient responsibility for their own care, if that’s even feasible. (Decreasing the Medicaid rolls will help but would burden ER’s with unpayable bills.) Oh, and tort reform. I honestly don’t think it’s as big a burden on the system as especially right-wing lawmakers believe. I know some plaintiff attorneys and occasionally look at cases for them; they reject 99 out of 100. Maybe there’s no way to stop docs from ordering too many tests anyway, but patients need recourse from bad medical care. Oh, well, that’s my 2% worth!

  2. william brown
    August 3, 2012 at 11:56 am

    Doc: I’ve got this problem that only you can fix. Shouldn’t MDs know the difference between “its” and “it’s”?
    And no doc (unless he’s Capt Kirk) should “phase” a patient when he means “faze.” Sorry, Doug, it’s the editor in me.

  3. Pat
    July 30, 2012 at 5:58 am

    I’m not at all surprised by the media response. It is the logical reaction from a society that views doctors as a raw materials, a commodity to which they have a right, ipso facto wishing us to exist should simply make it so.

    Tough truth kiddies, but if you are a doctor, all the non-doctors think that they own you.

    • Theresa, MD
      August 1, 2012 at 12:29 pm

      The problem is Doctors think they have to bill the insurance companies for their patients thereby putting themselves in the middle so now the patients and the public think that health care is a “right” as well as the street signs and clean water.

      Why not go back to the good old days where the patient is sent a bill and he/she is required to send this to insurance company in order to be reimbursed, same as lawyers and dentists.

      As a physician I have a “right” to affordable legal care, my husband and I have paid thousands to a lawyer in a custody case and I think this should be subsidized by my fellow man. Why should I bear the brunt of the onerous legal system myself. Especially because the lawyers made the laws, not me!! Haha!

  4. Marsha McKay DO
    July 30, 2012 at 1:39 am

    Hey Doug,
    Maybe I missed it somewhere, but I never did know why you left your practice and went to a completely different place many states away. Perhaps it is none of my business but I am curious because it is no joke to leave a practice and move far away.
    I dream of leaving my practice almost every day. I am a solo doc in a small town in the California Sierra mountains. The local hospital owns all but 3 practices now and basically calls all the shots in the town medically. In order to stay solvent, I also take care of two small county jails to have income without overhead. I have all the electronic bells and whistles of an EMR and so on and last year I qualified for the $18,000 payment for “Meaningful Use” of an EMR. What a joke, I have yet to see any money 8 months later due to a series of screwups by the Medicare program. I definitely will not be in the data mining program next year, it took more time than I could believe to deal with all the documentation. I’ll take the pay cut , much cheaper than being in the program. If the pay cut gets too big, I’ll drop the Medicare program and listen to the screaming from all the people in this retirement community. I really do like my patients but they have NO IDEA what it takes in time and money to be in these programs. Someday I am going to get some big deal administrator in the Incentive EMR program on the phone and let them know how it really works. Thanks for listening and I hope you like your new job. I worked in Urgent Care for 8 years in Seattle and boy was that an education in patients and how and when they seek medical care.

    • Doug Farrago
      July 30, 2012 at 7:41 am

      I needed a change in life, Marsha. My wife’s family is from Virginia and I went school 25 yrs ago at UVa so that is why I came back. I also became frustrated with the administration at my past job and how they treated doctors. Your situation is what I am hearing from around the country. I am now working for a company called MedExpress. It is well run and so far, so good. Look them up since they are always looking for good docs (I think they are only on the east coast, though)

  5. July 29, 2012 at 1:03 pm

    This article from the NY Times is very interesting. I live in the OC and consult in Health IT and the comparison between counties in So Cal here is interesting. The article makes mention about doctors preferring to live in Orange and Los Angeles counties, and that is true and myself I feel the same so why would doctors not feel this too.

    The interesting comparison though is just the opposite for Orange County and I can’t speak for Los Angeles county but would imagine some of the same might exist there and see some of this in the Long Beach area of LA county as well. You go into doctors offices, clinics, etc. and there’s plenty of room to get in. There’s no crowding at the retail clinics or long lines either, I see it myself. So in the OC marketing is huge to compete, as we do have the some of the same issues here with people not going to the doctor as people can’t afford it.

    Overall the shortage situation is right and the OC may just be an odd example of where we have “pockets” of doctors available but it’s like the old real estate saying “location, location, location”. You can see sparsely populated waiting rooms all over the place in the OC. Contracts make a big difference too as when you get into the areas to where Medicaid patients are seen, it changes with having one heck of a hard time finding a doctor in the OC who will accept the reimbursement as it is one of the lowest in the US. The only area where compensation is decent in the OC for Medicaid is with obgnyn pre-natal care as they want healthy babies but after that it’s back to bare bones.

    If you want to take the “long view” of how this occurred you can go back to the mortgage situation created by bankers as people moved by the groves a few years ago as they could afford to buy a house out there and no need to repeat what happened, but you have a lot big companies out there in the inland empire with warehousing facilities employing a lot of not highly skilled employees and not making a lot of money that still need healthcare and that’s the market out there, the poor get hit again connecting back to what happened with banks and why I started my series called “The Attack of the Killer Algorithms” as analytics for profit drove all of this activity and the sad result is what we see today.

  6. CancerDoc
    July 29, 2012 at 8:49 am

    I personally think that tort is a HUGE part of the problem: not just for healthcare, but American progress in general. I read somewhere (and I hate that I don’t have a link to the source; was it here?) that only 1/6 of the mal-practice premium goes to compensating injured patients. The rest is eaten by administrative costs, lawyer fees and insurance company profits. The cost of litigation is stifling every aspect of our society (except for the lawyering segment….). Talk about a non-productive “investment.”

    I work in a rural community. The majority of the primary care is being provided by nurse practitioners, who seem to have limited over-sight. I believe they increase, rather than decrease, the cost of primary care. Because they don’t have experience, they over-refer.

    Oh….btw your idea for the cell phone premium. Did you know that there is a federal program to give out free cell phones? My mother volunteers at a food bank. One of the clients noticed that another volunteer had an old cell phone. He told that volunteer that she needed to get a new one. Her response was that she couldn’t afford that. He told her that “Obama” was giving cell phones out for free — he had gotten 4 so far. “You just have to give them a different address every time you go. They don’t check. Make one up.” Lovely.

    • Doug Farrago
      July 29, 2012 at 10:45 am
      • Burton Mendel
        August 4, 2012 at 8:03 pm

        It’s true, Doug! I was going to point this out to you as a counter argument to your otherwise justifiable ‘medicaid fee’. Since the taxes of working Americans pay for both Medicaid and the free phones, we’d only be adding to our own tax burden.

    • Kurt
      August 1, 2012 at 5:45 pm

      Until there is a “Patient Accountability Act” fat diabetics are going to keep eating garbage and suffering sequelae. Primary docs are going to held accountable for what happens to their patient population with no consideration that “we” don’t stuff the McDonald’s down their throats. I tell med students to specialize and stay away from primary care. I have more uncompensatable paperwork to sign, EMR is making one’s income drop due to not being able to see as many patients and F.P.’s are pushed out of hospitals. The AAFP responds with the “money-making” MOC crap as
      residencies are filled with 43% FMG’s as the “native” grads can see
      the specialty doesn’t have a future.
      The AAFP doesn’t care because they can just re-hang out the shingle and call it the Academy of Family Nurse Practitioners. I repeat, “There is NO future in Family Practice anymore.” Why go to med school and residency when NP’s are going to be taking over?
      Take away the hospital and one is doing NP work. Only difference is a doc and prescribe the narcs and ADHD drugs. For this you go to med school and 3 year residency?
      A bunch of us baby boomers are going to get old and need services.
      It doesn’t matter how “good” we take care of ourselves because eventually we will die no matter what are likely to require help of some kind towards the end.

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