Short Changed: How to Address the Doctor Shortage

This referenced article made its way around social media recently. It is actually a response to a prior article Congress’s Doctor Shortage, Trillions for Covid relief, very little to address medical training (https://www.wsj.com/articles/congresss-doctor-shortage-11609802722?mod=article_inline). Those of us who follow this topic already know what they wrote:

“Hospitals in much of America are triaging Covid-19 patients because they are short of staff, especially doctors trained in emergency-care and anesthesiology. Blame Congress, which rationed the supply of new physicians two decades ago and is only now addressing its mistake, albeit not nearly enough.”

            This has been a contentious topic of discussion for many of us. Many of us profess that this is a physician problem to solve, and I believe it truly is, however it really lies at the hands of Congress. However, what I also mean is that it is not fodder for the advancement of scope of practice of mid-level providers. Unfortunately, this is precisely what has taken place. The physician shortage has become a weapon in the scope creep charade being perpetrated on the American lay public who don’t know any better. However, this article reports good news “The $900 billion relief bill adds 1,000 new Medicare-funded graduate medical education (GME) positions over five years.” Now some of you might say it’s a little too late, or not enough, and I agree with both of these sentiments, but at least it’s a baby step in the right direction. 

Another problem Congress overlooked is the aging U.S. population and physician workforce. A third of the 906,000 or so practicing doctors in the U.S. are over age 60, and the Association of American Medical Colleges (AAMC) forecasts a physician shortage of 54,100 to 139,000 physicians by 2033. Shortages will be especially acute in geriatrics, primary and emergency care.

            And then medical schools expand enrollment which increases graduation, but what happens is a bottleneck at the residency process. So, increasing med school positions does not increase the number of physicians as there isn’t a corresponding increase in residency positions. Then unfortunately, “Some health economists say technology and nurses can substitute for fewer doctors.”  Nothing could be further from the truth. Only physicians can substitute for physiciansThe responding article states “Physician substitutes including physicians assistants and nurse practitioners can often provide adequate but not equivalent care to board-certified physicians. If these substitutes were in fact equivalent, we should stop spending time and money educating physicians.” 

            The response article reports the problem as four-fold whereby (1) given the cost of the GME, “Restructuring graduate medical education by increasing the focus on community-based care and ambulatory-based surgery to supplement hospital-based care would result in a more cost-effective method for achieving this goal,” (2) “The second problem of health-care consolidation has been a result of obsolete antitrust laws that encourage health-care consolidation resulting in less competition,”  (3) NP’s and PA’s are not physician substitutes, and (4) Approximately one-third of practicing physicians are over the age of 60 and more likely to retire.

            There are some interesting comments to the article. Follow the link above. 

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