Obamacare Means 1/3 Fewer MDs

[daenku32]

Actually,
I think I need to side with Wildcat on this one. looking deeper into the issue, it's clear that the AMA has actively sought to limit the number of doctors produced as a means of salary controls.
http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm



I've just lost a lot of respect for the profession.

Here is the current line from the article:
Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

But this is really besides the point, because AMA doesn't actually control the number. Their power is mostly as advisory. And only 15% of doctors are members of the AMA (wiki).

Going back to the USAToday article about the real limits for having more doctors, you are looking at Government Subsidies. The lack of them is creating the shortage. Which is quite frankly a direct result of people not wanting to "throw money at the problem".

 

[JoeTheJuggler]

The medical profession is controlled by a guild^WP. To call it a tin foil conspiracy theory when someone refers to one of the purposes of a guild as limiting competition is roughly the same as calling it tin foil hat territory if someone says that one of the purposes of a union is to get higher wages.

Again, even if this conspiracy theory is true (and the AMA is conspiring with Congress to limit the number of MDs), this has nothing to do with "Obamacare", right?

The argument Neally is citing is that something about the proposed healthcare reform is going to cause doctors to quit the profession in droves.

 

[JoeTheJuggler]

Here is the current line from the article:
Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

If that's all the AMA conspiracy is based on, it sounds rather like the reverse of the Yogi Berra line: "Nobody goes there anymore; it's too crowded."

And again, that's not the argument this thread is really about anyway, since it has nothing to do with the current health insurance reform proposals.

 

[Schrodinger's Cat]

First off, this statistic is contradicted by the fact that both the AMA and the new England Journal of Medicine states that 70% of health care providers are in favor of health care reform.

I work at one of the top hospitals in the world, in Boston. There are several other hospitals which are among the top hospitals in the world which are in boston as well, as we are a huge medical hub. Every top hospital in the city has been lobbying for health care reform for over a decade.

So yeah, maybe your stupid, barely passed medical school yokel doctors who got their MDs at a degree factory who don't know what they're talking about are against health care reform.

I think I'll stick with what the top hospitals and doctors in the country think, thanks.

**oh, also the fact that I've been working in hospital finance and think private health insurance companies are just simply the most evil institution on the planet. My concern isn't really with a public option, but it IS with healthcare reform and regulating the industry. Maybe if your job was listening to crying mothers on the phone who have paid thousands of dollars in health insurance premiums over the years who now is seeing their 7 year old getting denied cancer treatment as not medically necessary by Blue Cross Blue Shield, you'd understand.

further edit: **although, I have to say that I have little faith that our government is going to reform in a way that actually is relevent to the industry. Considering that the people who seem to have the loudest voice on health care reform are tea party members who have no experience in health care, while actual physicians and hospitals are hardly included in the debate at all, I have little faith. So I should say that I am in favor of reform which will actually regulate the industry in a way to protect health care providers and patients from the frankly evilness which is private insurance, not necessarily whatever reform is going to come out of this health care "debate." As for the public option...I like it in theory, but I can admit to myself that I just don't know enough about economics to know whether it is plausable to implement effectively, so on that I have little opinion.

 

[willhaven]

Here's the survey: http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx

Key Findings from The Medicus Firm Survey

Physician Support of Health Reform in General
• 62.7% of physicians feel that health reform is needed but should be implemented in a more targeted, gradual way, as opposed to the sweeping overhaul that is in legislation.
• 28.7% of physicians are in favor of a public option.
• 3.6% of physicians prefer the “status quo” and feel that the U.S. health care system is best “as is.

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

Health Reform, Public Option, and Practice Revenue/Physician Income
• 41% of physicians feel that income and practice revenue will “decline or worsen dramatically” with a public option.
• 30% feel income will “decline or worsen somewhat” with a public option.
• 9% feel income will “improve somewhat” with a public option, and 0.8% feel income will “improve dramatically” with a public option.

Health Reform, Public Option, and Physician Supply
• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.

Health Reform and Recommending Medicine to Others as a Career
• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

Ready for rationing?

A total of 1,195 physicians from various specialties and career levels in locations nationally were surveyed. Nearly one-third of physicians responding to the survey indicated that they will want to leave medical practice after health reform is implemented.

This combined with the expected increase in demand could result in 50% reduction in available physicians.

http://www.nejmjobs.org/rpt/health-reform-may-reduce-physician-workforce.aspx

So 46.3% feel like they'd be forced out or would want to quit. That doesn't make it a reality. Change to a longstanding system won't be welcomed with open arms, but the proof is in the pudding and this is a survey not a study of what will actually happen.

If there is increased demand, there will be doctors there ready to fulfill that demand. If we look at Switzerland, they've got no public option and they've got an individual mandate to buy private insurance. Their system is cheaper than ours and ranks more highly according to the WHO. I'm not aware of a mass exodus of doctors in 1994 when they adopted their new system. I'm also not aware of health rationing in Switzerland.

 

[DC]

Here's the survey: http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx




So 46.3% feel like they'd be forced out or would want to quit. That doesn't make it a reality. Change to a longstanding system won't be welcomed with open arms, but the proof is in the pudding and this is a survey not a study of what will actually happen.

If there is increased demand, there will be doctors there ready to fulfill that demand. If we look at Switzerland, they've got no public option and they've got an individual mandate to buy private insurance. Their system is cheaper than ours and ranks more highly according to the WHO. I'm not aware of a mass exodus of doctors in 1994 when they adopted their new system. I'm also not aware of health rationing in Switzerland.

since the 80's the number of doctors / 1000 people is growing.

http://www.obsandaten.ch/indikatoren/5_1_1/2006/d/511.pdf

 

[Neally]

Here's the survey: http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx

So 46.3% feel like they'd be forced out or would want to quit. That doesn't make it a reality. Change to a longstanding system won't be welcomed with open arms, but the proof is in the pudding and this is a survey not a study of what will actually happen.

Thanks for the link. We will see what happens, and while no doubt saying and doing may not match, as mentioned in the original article, even if a fraction actually follow through in quitting, or retiring early, it could in fact cause wait times to increase.

Interestingly, there was no mention of funding of the survey by Murdoch or anyone else. Seems like a straight forward email survey. Ah well, conspiracy nuts are hard to crack.

 

[GreyICE]

I see you ignored the second half of my post that you quoted. You are jumping to the conclusion that because I don't entirely accept your argument then I must necessarily accept the argument you are arguing against. Not true. I accept neither that the poll was DEFINITELY done with good methodology (Neally's argument) or that it was DEFINITELY done with poor methodology (Your argument). I accept neither argument until more evidence is brought forth for either side. You are both presupposing and that is what I am arguing against.

Furthermore, you are making an ad homenim argument against a study possibly done by an organization that is probably untrustworthy. You are saying that since the organization performed the study, it is therefore useless.

Reading comprehension fail. The fact that the study isn't findable, verifiable, or in any way testable makes it worthless. If the study is done well, it's worth something.

This is also an example of Murdoch's dishonest flavor of 'journalism,' but it's the fundamental flaw of the study not, well existing in any verifiable form that makes it useless.

 

[GreyICE]

Neally, 1 sentence this time: where's the original study (third time I'm asking, too)?

Neally, take 4. I see you keep speculating with this study that you can't seem to find.

 

[McHrozni]

Where are you pulling that number from?

It's my estimate, but it's founded in fact.
USA has 2.3 physicians per 1,000 people. France, Germany and Switzerland for example have about 3.5.
http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people

Considering how much the US doctors are paid, I find it very improbable that increasing their number wouldn't drive down their paychecks, which could easily reduce the overall medical costs in the US, seeing as the proportion of medical costs going towards their pays is over twice to that in, say, France and Germany. This would obviously take time, possibly as much as a generation. But the current health system in the US is suffering from major problems in part because the doctors are so expensive. Fixing that should be a priority, but expecting people to work the same for less isn't going to work, so the only other approach may be to force them to work less for less, because of increased competition and the resulting shared workload.

Even if you disagree with that, I'm sure we can agree that reducing their number further wouldn't be beneficial at all.

McHrozni

 

[joobz]

The current health care system is specialist driven.

A Family practice physician can expect a salary of 135k/year (with 3+ years experience).
The next lowest grade is Podiatry, which gets paid ~40k more/year.
It goes up from there.
There's a disincentive to be a primary care physician and those are what we generally need most of.

 

[Rolfe]

I don't know anything about the medical system in the USA, but I do know that in Britain the RCVS limits the number of places in veterinary schools to try to avoid over-supply. They have been known to get it terribly wrong though, but fortunately their advice to contract significantly in the mid-1980s wasn't followed. The main reason is that these university places are heavily subsidised, and the country doresn't want to subsidise training of personnel it doesn't need.

This has all gone a bit weird since we were obliged to accept any vet with a European degree to work in Britain, and some European countries definitely do have an over-supply. But somehow we survive, and I've made some lovely Spanish and Portuguese friends. (They report excellent universal healthcare in their home countries by the way.)

Recently one university opened a new veterinary school, because it was clear the influx of foreign graduates meant that we were under-supplying - even though the six existing schools have all markedly incrased the numbers graduating. That new school should be producing its first graduates this year, when it will have to pass the RCVS accreditation in order for the degree to be recognised. That's how standards are kept up.

Over and above all that though, all the schools can take extra students paying full fees, over and above their quotas, if they have the facilities for them. Most of these are foreign students, and some of these are funded by their home countries.

I have a feeling the medical schools have a somewhat similar system, with the NHS having a fairly big say in how many new graduates it thinks it's going to need. It's not at all unusual, and it's not at all unlikely that a similar quota system exists in the USA for medical schools. You don't want to subsidise more trainees than you need (if you are subsidising them), and you don't want to take high fees from students for a long and arduous course if there's not going to be work for them when they finish.

Rolfe.

 

[Dancing David]

http://www.themedicusfirm.com/pages/survey

Specialists (all other) 65.7%

 

[Rolfe]

Maybe if your job was listening to crying mothers on the phone who have paid thousands of dollars in health insurance premiums over the years who now is seeing their 7 year old getting denied cancer treatment as not medically necessary by Blue Cross Blue Shield, you'd understand.

Please tell me that doesn't really happen!

I mean, you're the people that keep telling us you don't want universal healthcare because you don't want "some bureaucrat" standing between you and your doctor! What's THAT, if it isn't "some bureaucrat standing between you and your doctor"?

Hint. Nobody but my doctor decides what treatment is medically necessary for me, under the NHS.

Rolfe.

 

[joobz]

Please tell me that doesn't really happen!

I mean, you're the people that keep telling us you don't want universal healthcare because you don't want "some bureaucrat" standing between you and your doctor! What's THAT, if it isn't "some bureaucrat standing between you and your doctor"?

Hint. Nobody but my doctor decides what treatment is medically necessary for me, under the NHS.

Rolfe.

Oh, it's goofier than that.

Depending on who your insurance is with will dictate what medications get covered. If you have allergies, the insurance company may claim that allegra, singulaire, clarinex, Nasonex... are all equivalents and therefore only cover the generic allegra. All others you will have to pay for. In this case, if you are a patient who only responds to Nasonex, your insurance will not cover it.

These coverage agreements are decided between the insurance company, pharmaceutical supplier and pharmaceutical company. Your doctor has zero say in it.

In other words, doctors are forced to play drug matchmaker and determine which medications are covered by the plan and then prescribe that one. It doesn't matter if that is the one the doctor thinks is best.

 

[ponderingturtle]

Please tell me that doesn't really happen!

I mean, you're the people that keep telling us you don't want universal healthcare because you don't want "some bureaucrat" standing between you and your doctor! What's THAT, if it isn't "some bureaucrat standing between you and your doctor"?

See they are standing between you and your treatment(well payment for it anyway) not you and your doctor, totally different.

 

[Delscottio]

Oh, it's goofier than that.

Depending on who your insurance is with will dictate what medications get covered. If you have allergies, the insurance company may claim that allegra, singulaire, clarinex, Nasonex... are all equivalents and therefore only cover the generic allegra. All others you will have to pay for. In this case, if you are a patient who only responds to Nasonex, your insurance will not cover it.

These coverage agreements are decided between the insurance company, pharmaceutical supplier and pharmaceutical company. Your doctor has zero say in it.

In other words, doctors are forced to play drug matchmaker and determine which medications are covered by the plan and then prescribe that one. It doesn't matter if that is the one the doctor thinks is best.

Is this a common thing? Are the patients aware of what the doctor is doing? It seems utterly bizarre on so many levels.

 

[joobz]

Is this a common thing? Are the patients aware of what the doctor is doing? It seems utterly bizarre on so many levels.

Yes. Often times, they'll get patient input. Using the allergy example, the doctor will try the different meds to see which ones work with the patient.
they'll start at generics covered by the insurance company, then go to namebrands covered by insurance, then go to name brands not covered by insurance.

 

[The True Scotsman]

Reading comprehension fail. The fact that the study isn't findable, verifiable, or in any way testable makes it worthless. If the study is done well, it's worth something.

Cool. I agree. (except for the first 3 words)

This is also an example of Murdoch's dishonest flavor of 'journalism,' but it's the fundamental flaw of the study not, well existing in any verifiable form that makes it useless.

Here comes my issue. You are assuming that it was done dishonestly, rather than simply with unintentionally poor methodology.

 

[Debaser]

28.7% of physicians are in favo(u)r of a public option.

Wow!...Between a quarter and a third of your doctors are dirty, filthy Commies? How can you let them touch you...especially there

Must be that damnable Hippocratic Oath and vowing to help anyone in need of aid. You'll want to get rid of that, quick smart.