“Behind the coming physician shortage”

CATO’s Michael Tanner in the NY Post:

In fact, we have already seen the start of this process in Massachusetts, where Mitt Romney’s health care reforms were nearly identical to President Obama’s. Romney’s reforms increased the demand for health care but did nothing to expand the supply of physicians. In fact, by cracking down on insurance premiums, Massachusetts pushed insurers to reduce their payments to providers, making it less worthwhile for doctors to expand their practices. As a result, the average wait to get an appointment with a doctor grew from 33 days to over 55 days.

Imagine that.

12 thoughts on ““Behind the coming physician shortage””

  1. I can only relate what my brothers have told me. Every year the payment to Medicare providers is scheduled to be decreased. Congrefs threatens every year, and last year used those ‘savings’ to bolster someone’s pet health care ‘reform’ package. The payments were then reinstated at the old rate.
    They will refuse to take Medicare patients. It is happening already. It will get worse because the assembly line for doctors is about 12 years [min] long, with new models having been in the factory since before the turn of the century. Clinton actually paid medical schools to take fewer students because ‘someone’ thought we had too many doctors already. [AMA?]
    They forgot that oldsters consume more resources than youngsters, and we were going to be getting a lot more oldsters ‘real soon now’.
    It will get a lot worse before it gets better, if ever. The government screwed around again with market forces and, as usual, messed things up.

  2. It’s like there’s this “law,” where “supply” and “demand” intersect, and if you adjust one, the other adjusts in response.

    Somebody in Washington should do some research on that, pronto.

  3. My brother lives near Boston. But his employer is located near me in Ohio, and spends about 4 days every other week here (the rest of the time he is in Asia). He now gets most of his medical care in Ohio, where it is much easier to get an appointment, and it is cheaper.

  4. Have you noticed this Wash Post article: Shortages of key drugs endanger patients?

    They spin it to sound like it is mostly the drug companies. In reality, the new FDA crackdown is causing most of it. Recently I found out one of the old standby’s for treating migraines is no longer available because the FDA decided that there had been no specific testing for one of the components. This is a compound that has been used successfully for decades. My guess is that this was simply one way they are beginning to thin out the meds they might be responsible for paying for under Obamacare. I wish someone with more research chops than I (and a bigger megaphone) would go rooting this story out.

  5. Remember that physician assistants and nurse practitioners have been added to the mix for about 25 years now. They need supervision but get very little. My ex-wife was an NP working for a GP near here for a few years. She used to call me for advice because the GP was always too busy. Ironically, she was the family “doctor” for my son’s wife’s family and they didn’t get the connection until later.

    The older generation of doctors is leaving early if they can afford it. The newer ones, based on my experience talking to students, do not work the same hours so it will take at least 1 1/2 of the new docs to replace one of my generation. Women physicians were discriminated against 50 years ago because admissions committees assumed they would not practice full time. Guess what ? They don’t for the most part. Women physicians work about 2/3 the hours of male colleagues.

    All these factors will contribute. Canada cut way back on nurse and physician training about 20 years ago. I never heard anything about the US. I do know that Medicare will not fund a residency position if it is filled by a physician who is a board certified specialist in another field. When my back was getting bad, I looked into changing to radiation therapy as the dynamics are similar to general surgery. Except you can sit down. A friend of mine had done it. It was no go for me, though. The rule now prevents changing specialties.

  6. Isn’t it strange that Leftists say that, in the case of education, the way to improve quality and access is to pay educators more but when it comes to medicine, the solution is to pay care givers less?

    It is almost as if there arguments depend on the Left’s degree of control of the field under discussion. Perhaps Doctors should unionize and pay protection money to the Democrats like the teachers do.

  7. hidden in the health care law was a repeal of the law of supply and demand.

    They still don’t understand why Eskimos are reluctant to buy their ice.

  8. You get what you pay for. And sometimes not even that. Raising prices back to what they were won’t bring the really good doctors back.

  9. Democrats have a theory that doctors are Republicans and the AMA is powerful like the NRA. Both are myths. Doctors, like all independent businessmen, used to be conservative and mostly Republican. Many were Democrats because of social issues, like abortion, but the days when doctors were businessmen are gone. The new physicians going to rural practice are doing so as employees of a hospital, like the young woman OB who was one of Obama’s white coat brigade. I looked her up. Those going to cities are employees of big medical groups that are increasingly being owned by hospitals.

    The only independent doctors left are those who are dropping out of Medicare and insurance and cutting overhead to the bone. Most are primary care but some are specialists and they are usually older and have some financial stability and no student loans. Student loans are making new medical graduates into indentured servants.

  10. There will be a push for foreign trained physicians, nurses and technicians to be “fast tracked” for certification. The feds will intrude on state’s rights (the regulaton of professions) again. As seen here in Canada, the fast tracked are frequently simply not qualified to our standards but the politicians will not care as they can proclaim ” I provided more doctors and nurses! Wait times are down! Vote for me!”

  11. Tangential: Texas had a doctor shortage; it changed its tort laws; doctors voted with their feet. Note here. The Texas experiment not unlike the Massachusetts one might indicate that having 50 petri dishes out there is likely to be more effective than having one huge Washington “plan” – not that we didn’t know that already.

  12. The increased influence and role of chiropractors in medical care is a political decision based on the theory that chiropractors don’t operate or prescribe medicines so they are cheaper providers. My current experience in dealing with the workers compensation world is that many orthopedists use chiropractors and PAs interchangeably. I recently talked to an orthopedist who was requesting authorization for an expensive procedure. His physical exam, signed by him, omitted crucial information. I pointed this out to him and he admitted his chiropractor had done the physical.

    Many of these “lesser licensed practitioners” make much more money than MDs. A friend of mine told me about a podiatrist friend of his who went to medical school after 10 years as a podiatrist because he wanted to do surgery in the hospital without an MD supervising his care. He practiced as an MD for a few years and went back to podiatry. It was “costing him too much money” to be an MD.

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