There’s an interesting post at Stateline about how states are trying to cope with the impending shortage of physicians. The estimated shortfall is nearly 100,000.
There are multiple bottlenecks but the most significant is in residencies:
Residencies often are the bottleneck in the physician supply chain.
The AAMC says that the U.S. has a shortage of several hundred residency slots as a result of a cap on Medicare spending on graduate-level medical education.
To translate that for you, the Medicare program pays about $85,000 per year to hospitals per medical resident. No subsidy—no new residents. The average medical resident earns $40,000 to $50,000.
The article mentions telemedicine and expanding the role of nurse practitioners and physician assistants as strategies but there are some things that go unmentioned.
The first and most obvious is automation. There is no sector of the economy so much in need of increased automation as healthcare.
I also wonder how much there’s a shortage of physicians and how much a shortage of internal medicine specialists.
Don’t rely on importing more foreign-trained physicians to solve the shortfall. The competition for internationally trained professionals from other OECD countries, e.g. Canada, UK, France, Germany, is steep. That’s one of the reasons that the wages for GPs are nearly the same in all major OECD countries. Other specialties aren’t nearly as portable and competition will do that, in this case high U. S. wages push up the wages of physicians everywhere.
Hat tip: RealClearHealth
I’ll bet there is someone here who could comment on the relative shortage. I’ll be shocked if internists aren’t in relative short supply. It would also be interesting to know the thinking behind turning so many into gatekeepers feeding specialists. My dad used to deliver babies, remove all kinds of skin lesions etc. now you get referred.
My experience with nurse practitioners has been rather spotty. ( eg dealing with a sinus infection is one thing. My wife was diagnosed with epilepsy. As we elevated the issue, eventually arriving at a very high powered guy, no real doctor arrived at the same diagnosis. But it’s on the med record. WTF. This despite the practice having been in all other respects quite satisfactory). They may be cheaper in singular cases, but I suspect there will be costs.
Internists, really almost all primary care, are in short supply. Slightly OT but this has effects beyond primary care. Our network could not find Pulmonary critical care docs to staff the new hospital we are opening in October. They talked with us and we are going to staff it with critical care guys from our specialty along with some mid-levels. AFAICT, we are just about the only private practice in the country to be doing something like this.
Why do primary care docs get used gatekeepers to feed specialists? It is the money. Providers do what payers pay them to do. Right now the trend is to expand catchment areas so that you can funnel the high return patients into the specialists and the big hospital in the network. Networks are using small satellite hospitals also to do this. With bundling starting up now and with hospitals creating their own insurance products, or joining insurers, and going at risk, this will change some.
As to the general topic Congress capped off the number of residency positions they will pay for at 1996 levels. When it was predicted that we need more docs, we increased the number of med school slots. About a 30% increase over the last few years if memory serves, but med students are easy. You get paid for them and teaching them is not quite so demanding. Residency is another story. It takes a much larger commitment to teach and train them. Most docs don’t want to do it. It slows things down and hurts revenue. Means longer days. Not sure how this will play out. I have had zero difficulty recruiting, so there has been no pressure from the network for us to have a residency. TG.
Automation? I think that is a long ways away yet. We do telemedicine. It costs a lot. We already use a lot of NPs and PAs. We will use more, but they seldom eliminate the need for physicians, just reduce the number needed, sometimes. On the flip side some of the surgical specialties have become quite adept at using them to increase billings, not so much for decreasing the need for docs.
Steve
If we negotiated residency standards in our trade agreements we’d likely have little problem importing medical personnel, but along with Germany and others we shelter this particular class of professionals. So everyone else gets shafted.
Sounds like we need more residencies to train the new graduates, yet, who is willing to give their slice of the budget pie?
On another note, in the rural Southeast, seems most of the rural specialists (cardiology, neurology, OB_GYN, etc) are graduates of foreign medical schools yet did residencies here. When my wife had a small bowel obstruction, did I care her ER doc was from Pakistan, her surgeon from Honduras, and her internist from the Philippines?
Ben- You need to pay people a lot more in order to get them to move. Canadians can come down here and work right away, and they would make quite a bit more with no new language to learn. Yet, few come here. You aren’t going to get many French or German docs to come here. They make relatively good pay there and the gradient isn’t high enough to lure them here, where they need to possibly learn a new language. The differential is high enough that we can continue to get Indians, Chinese and Pakistanis. What I, and others, have seen is a very wide gap between the better trained docs and the worse trained docs from these places. We have compensated for that by requiring that they do a residency here. Perhaps we could eliminate that since residency is the bottleneck by setting standards. However, my gut feeling is that won’t change things a whole lot. The Indian and Pakistani docs I talk with tell me that it is pretty stressful coming here and as conditions improve back home less will want to come here. Same for Chinese. Don know about Philippines, Honduras or the other Latin American countries.
Steve