I was a bit puzzled by this post of Matt Yglesias’s. He compares the situation in healthcare in 1911 with the situation today, suggesting that technology has resulted in the number of physicians rising sharply:
Clearly, though, this isn’t what’s happened in the health care sector. Instead, better health care technology has led us to want more health care professionals. A lot more!
Maybe I don’t understand what he’s saying but I’d sure like to see some facts to back up his assertions.
Note that he begins his post talking about doctors so let’s restrict ourselves to physicians. The number of physicians per 100,000 population in the United States in 1910 was 164. The number of physicians per 100,000 population in the U. S. today is roughly 277. Not a drastic increase by any means. But is it an increase at all?
In 1910 nearly all physicians were GPs. Today fewer than 100,000, roughly 12% of active physicians are GPs. That’s closer to 30 per 100,000 population. What has actually happened is that the number of specialists has skyrocketed and the number of GPs has plummeted. I don’t think that the actual facts support the story that Matt is telling.
A kneejerk response would be that the trend towards specialists is technologically driven. I’ll have to think about that. Maybe steve has a perspective.
A simpler explanation is that we’re subsidizing healthcare so we get more of it and that physicians elect specialties because the compensation is better.
Maybe Yglesias might have read Paul Starr’s book. I re-read part of it this w/e while in DC judging national speech and debate finals. Anyway, in the early 1900s, medical care was very inefficient. Transportation was still very difficult. Communication was still developing as the telephone was not universal. So, doctors saw way fewer patients then, than they can now. Docs often compounded their own medicines, granted they did not work often, which also took time. Also, a lot of those docs were DINOs (doctors in name only).
Docs had little to offer back then. Their care was often just giving basic advice (handholding) or giving a diagnostic name to a condition they could not treat. Surgery was just really starting to take off as surgeons converted from antiseptic technique, worked poorly, to aseptic technique.
To give an extreme example of how different things are now, during Desert Storm, we had a severe food poisoning outbreak (salmonella/shigella). It hit all of the docs in the area except for me and a general surgeon. I saw about 20 patients an hour for the better part of two days straight. I could do a basic exam and history, but I ordered lab tests, x-rays, IVs and medicines as needed and other people did all of that. In 1911, a physician had to do almost everything himself, including traveling to the patient.
Steve
Jevon’s paradox for healthcare?
I would question whether doctors today and doctors of 100 years ago are at all comparable.
My explanation is the medicine is much more complex and therefore requires more specialists. I predict the trend towards specialists will continue.
Here’s something worth reading that touches on these points.
Perhaps he was referring to the increase in nurse practitioners and physician’s assistants? I had a mild problem with my knee a while back, and made an appointment with the ortho department at the med center. The lady scheduling my appointment said I would be seeing so and so. I had the department’s TO in front of me and saw that so and so was a physician’s assistant. I mentioned this — in a kind of a weasley, gosh-he’s-not-a-doctor voice that she picked up on right away. The PAs, she told, can do everything a physician does except surgery. My visit involved x-rays, etc, and it was entirely satisfactory to me.
I have a completely off-topic question for the numbers folks here: anyone have any comment on BitCoin? http://www.bitcoin.org/ I’m curious what to think of this phenomenon — a non-state currency.
BTW/ I’m joking about Jevin’s Paradox, which is about increased efficiency decreating a limited resource. Healthcare is not a limitted resource.
michael: Haven’t heard of it; sounds illegal to me.
Let me clarify “illegal.” If a contract measured in bitcoins was brought into court, I suspect it would not be enforced. It would be tantamount to coming into court with a contract, promising to pay in sex, drugs and rock ‘n roll.
By your own figures, the number of doctors per 100,000 Americans has increased by 69% over the last 100 years. 69% seems like a significant increase to me. I think technology, along with the increase in medical knowledge and capability, has resulted in doctor specialization, just as it has in numerous other areas (engineers, lawyers, physicists, etc). Perhaps the main reason we have more doctors now is that we can afford them. We, as a people, have become wealthier.
I think it’s just a lazy post, since he’s really talking about teachers, not doctors. Obviously the total number of healthcare professionals/100,000 has gone way, way up in that time period, just not GPs.
What’s weird is that he’s contradicting his own past arguments about classroom size, i.e. here.