So sorry, the doctor isn’t in
There’s a doctor shortage, in case you hadn’t noticed. And it’s likely to get worse as a result of Obamacare:
This disease can be traced back to 1997, when Congress, anticipating a doctor surplus, included a section in its budget-balancing law that froze the number of Medicare-sponsored residency positions.
But instead of a surplus, a shortage soon developed, and has worsened over the years, now reaching epidemic proportions. The Association of American Medical Colleges Center for Workforce Studies just reported an anticipated shortage of 90,000 doctors of all kinds over the next decade, with half of them being primary care physicians and the other half surgeons and specialists…[What’s more,] the new health care law, known ironically as the Affordable Care Act, is promoting and extending the kind of low co-pay and low deductible insurance that is easy to overuse, overwhelming doctors further and leading to an upward spiral of health care costs.
I recently had the need to change my primary care doctor, and let me tell you it wasn’t easy to find a new one. Helpful friends gave me names of doctors they knew and liked, but when I called the offices, I got the repetitive answer: not taking new patients, and no idea if or when they ever will.
And I’m not even a Medicare recipient. I hear that for them it’s worse, and getting lousier all the time.
It reminds me a bit of the old Soviet system, where a person could go to a restaurant and see a menu that was largely delusional. That’s the stuff we would be serving, the stuff we’d like to serve—if we had it, which we don’t. What’s actually on the menu? Well, there are the potatoes. And then there’s the potatoes. And oh, have we told you we have potatoes?
My doctor problem was solved, for now, by the intervention of a friend who knew a certain doctor well, and who pleaded with him to make a kind exception and take me on as a new patient, which he did. When I arrived at the office, the receptionist was stunned when I told her I was here as a new patient, “Wow, you’re very lucky. He’s a wonderful doctor, but he’s generally not taking any new…”
This particular doctor is in his early 60s, and I’m starting to hope he doesn’t want to retire any too soon. I’m not eager to enter the doctor fray again in a few years. By then, who knows how tough it might be? I got a foretaste today because I’ve also been dealing (unsuccessfully so far, I might add) with trying to phone the DMV to ask a simple question.
Good luck, I know. Fifteen phone numbers and an hour or two later, I’m still waiting for an answer.
One of my business partners has son in medical school in New England, and he reports regularly on changing views of his classmates. Like many college kids, they were big obama fans, figuring that working for a reformed health system would free them from the hated insurance companies. But now as they take out each years tranche of loans, it’s getting through to them that under obamacare they may make less than plumbers as most European MD’s do. Yep go to school and traiing for 8-10 years with huge responsibilities and get treated lke dirt.
The problem is that the administration doesn’t understand the difference between the ‘cost’ of something and the ‘list price.’ By fiat they can make the official list price anything they want it to be, but the law of supply and demand determines what will happen then–e.g., shortages. Or, more cynically, they know the difference and think voters don’t.
My father, a doctor who retired a few years ago (he’s 75), recently attended his medical school class reunion. Many of his classmates had opened up their own practices (as the only doc or with one other doc), and were still practicing with mostly out-of-pocket customers. At this level, they have relationships w/their patients and can be flexible with payments when money is tight. However, all of them will be retiring within the year because of ObamaCare. Small practices have a small margin, and they cannot afford the expense of the government-mandated software (costing tens of thousands – don’t remember the exact amount).
I wonder how many doctors we will lose over the next few years as a result of one seemingly minor regulation or another buried within that 1000+ page HCR bill…
I am near 50, haven’t had a doc since i was in my teens.
sigh…
Ahhh! The wonders of central planning.
In my oncologic subspecialty, the “best and brightest”, all academic medicos, worried about the coming oversupply 15-20 yrs ago and wanted to reduce the number of training slots. Didn’t happen, because none of them wanted THEIR program cut; just everyone else’s, especially the less prestigious programs.
The trainees do a huge share of the work of patient care, the often-invoked but seldom honored concern of the medical Academy. I figured out early that patient care and teaching were the tasks academic docs respected least. So I left, taking my tenure with me.
There will never be a shortage of proctologists in Washington.
No worries. Obama is going to fix it. He said so. Plus, I see that some of the Democrat candidates are now running on the notion of fixing what they’ve screwed up in the first place.
We’re just a nation of stupid ingrates, is the thing.
Between 1960 and 1980 the US doubled its yearly new doctor output. Flat line 1980-2000.
Copy and paste to browser:
http://content.healthaffairs.org/cgi/content/full/22/4/71#F1
for more info.
I used to practice in the health care area and it was obvious back in the 1990s that we were heading to rationing and a reduction in the amount of doctors. With a shortage of doctors, Health and Human Services can bring in more foreign medical graduates, who will work cheaper and be much more mallable to the government’s will.
Who cares how many doctors there are? Health care is free. There should be enough sand to bury everyone’s head?
Today, more than 50% of docs finishing their training in all specialties are taking salaried positions, especially with hospitals. The new primary care doc becomes a “hospitalist” or works for a hospital in a primary care office. Try to get one after 5pm! Go to the ER, and wait your turn with a hospital-employed doc.
Vertical integration is the desired norm for all healthcare CEOs. The doc doesn’t really work for the patient anymore. More and more communities are becoming like Rochester MN, with no MD listings, none, in the Yellow Pages. There’s no need–they all work for Mayo in Rochester MN.
Office paperwork is one of the killers. Docs need insurance clerks more than nurses; the clerks add no value to patient care-they are cost centers.
Medicare has mandated conversion of all records to digital form, with the hardware and software costs exceeding $10K per doc. Patient confidentiality is, or will soon be, a casualty of the new era.
Government intervention in the economy. Is there anything it can’t fix?
Damn, you got potatoes? You must have had juice.
Shortly before the fall of the Berlin Wall I was invited to speak in the late unlamented USSR. The first two days in Moscow provisions for my wife and me amounted to …a bowl of cold peas each and a (shared) tin of potato chips. (True story.) Lots of restaurants, but either there was no chow or the staff couldn’t be bothered to serve it, preferring instead to play cards. (Even bribery with dollars had no effect.) The only alternative was to get in line at the Moscow McDonald’s, in which case we’d be getting up to the counter just about now.
But, of course, this time socialism will work, ’cause we’ll have the right people in charge. OK.
I’m on Social Security disability for MS. As part of the coverage, I’m entitled to subsidized housing. I’ve been on the waiting list to get on the official waiting list for 11 years. I also get food stamps – 22 bucks a month.
I sometimes wonder how many thousands of taxpayer dollars go to fund all the layers of government agencies to get me the 22 dollars I receive. Without the help of family, friends, and church I’d be living on the street.
I consider myself to be the recipient of charity and I thank all of you who pay taxes. I have no right to anybody’s property. I feel ashamed. I wish that I could give something back.
Rupert,
You just did give something back. Gratitude and insight. God Bless you.
Occam’s Beard points out a significant lesson from this–the government made a decision about the health care economy, specifically about needs and markets in the future, and it turned out to be wrong. Yet we were assured that a thorough upheaval in the area would result in certain desirable consequences. On what basis did anyone believe that?
I wonder if anyone can point out, here or abroad, similar government economic predictions that turned out to be true and if they did, how many others turned out to be wrong, often disastrously wrong?
The idea that governments can figure out which way an economy is going and plan accordingly is buried under an avalanche of evidence. Only the reality-free, which includes most of the left, would maintain otherwise.
Cash is king. You’ll see more of that from the surviving medical professionals. You’ll also see more business flowing to those calling themselves ‘medical professionals’ to avoid bureaucratic roadblocks. These are dangerous times.
Congress enacted a law that had unintended consequences? Shocking, I tell you! /sarc off/
I’m more familiar with the nursing side of medicine–my sister has been a nurse for 35+ years, mostly in emergency rooms. Burnout is a reality for the nurses, has been for years, mostly caused by staffing shortages and brutal shift schedules, and Obamacare has no hope of changing that (pun intended). Sis loves the field, but is nearing the end of the line. Her love of patient care (as opposed to management or administration) has kept her from getting burned out, but she isn’t getting any younger, and the work doesn’t get any easier.
Rupert, you have no reason whatever to feel ashamed. I’m happy to pay taxes (!) to help people such as yourself, who want to contribute but with the best will in the world cannot.
It’s the Aunt Zeitunis of the world who draw my ire, those who consider that, while they’re perfectly able to contribute, do not, but instead consider that they’re owed what they want…because they want it.
I was in Ontario in the mid-1980s, when a decision was made to restrict the size of medical school classes as a cost-cutting measure. I thought this was odd — how does fewer doctors bring costs down? — but I didn’t pursue the thought.
Later, the answer became clear: people who are waiting for care don’t cost the system anything.
Central planners see the Community Clinic as the model for the future, with an increasing number of “extenders” – physician assistants, nurse practitioners, etc.
Community Clinics are now called Community Health Centers, because it sounds better. Actually, they’re called CHCs, because three-letter acronyms carry a sense of familiarity and permanence.
Some constituencies, such as organized nurses, don’t care for the political dominance of doctors. Nurses in many jurisdictions are organized by the SEIU. Rep. Jan Schakowsky is a big proponent of mandates to hire more nurses. She’s a “friend” of SEIU. She’s a big proponent of the “single-payer” system. When the government covers everybody there will be no choice but to hire more nurses.
It has often been been stated that under a government plan, an office visit with a provider will resembel a visit to the DMV.
Following from that, the doctor shortage will make getting authorization for surgery resemble a visit to the Building & Safety Department to get a permit.
Enjoy.
Rupert,
your not the problem… the “alternative to statism” are not hard asses that would let people starve on the street, we just dont believe that, as you point out, that each layer gets a grab at the charity basket on the way to the poor…
there was a time when the donation in church were give a little take a little… that is, if you were too poor, you got some, if not you tithed some…
when i remember (sorry), i buy food and bring it to the church.
if i can save one family once in a while from eating that god forsaken block of american cheese (which is good cheese, but not in a block), i have done a good thing.
i know what ketchup soup is like…
and park benches…
and slums…
the truth is, that the “alternative to statism”, really do want to help people do what they can do. and the truth is, if you can type and write cogently as you did, then you can do something useful.
our society thanks to socialists no longer has room for everyone, only the best and healthy… minimum wage and other things insure that.
The full beauty of central planning in health care has yet to be exposed in the U.S.
I am a physician in solo practice, now 60 years old, and am having to look hard at my options. I love my profession and my patients, but it is clear that surviving solo with the traditional insurance/Medicare model will be nearly impossible in the near future. The upcoming massive increase in expenses and administrative burdens are huge: quality reporting (pay-for-performance); government- mandated EHRs (which must be certified; my current, highly capable and efficient EHR won’t qualify, requiring purchase of an entirely new system, 6 figures in cost); mandated compliance programs.
The changes occurring in this profession are tectonic; nearly 70% of the formerly private solo/group physicians in my community have signed on with the hospitals, out of fear or resignation. When the money crunch comes (and it will, in spades), hospital-employed physicians will be squeezed hard, and forced to toe the line (financially-driven) or be fired. Those of us who hold out are already squeezed, especially specialists, since the hospitals steer all referrals to their in-house boys.
Many of my peers are retiring far earlier than they would otherwise. These are the workhorses, who’ve been cranking out 70-80 hours a week forever, unlike the new crop of docs who want their 40 a week, no nights, and paid vacation, thank you very much.
One thing I am exploring with a fair amount of seriousness is going cash-only. I can offload all the federally mandated BS and overhead, reduce employees, and cut overhead, allowing me to charge fees at substantial discount to what I currently do.
It would not surprise me if this trend grows significantly (nor would it surprise me if the government tries to restrict it).
The times, they are a’ changin’, as Dylan sang. Fasten your seat belts, stay healthy.
Dr. Bob: Are you in New York?
Seriously! I would be very interested in forming a connection with an MD who would take cash payments. I’m already paying $599/month for individual health insurance (I’m a freelancer). My dad, who used to be a health insurance executive for Provident, which wrote group policies for corporations, says he thinks we should go back to the major medical policies, which were designed to cover things like accidents, surgery, and catastrophic illness, not routine office visits.
Some policies like that are still around, for instance via Freelancers Union, but they’re going to be outlawed soon, if they haven’t already via Obamacare. We really need to push for REPEAL, not tinkering around the edges.
“Do not let the camel get his nose into the tent!”
I’m in the Northwest, but hey, it’s a direct flight to Seattle
Oh, and one more recommendation: get an HSA plan, and contribute the max. This will give you the freedom to pay cash for medical services, and still get the tax deduction.
Thanks to all. I get by on the well wishes of others more than the government check.
It’s a strange thing to go through. This may sound antiquated but government checks steal a little bit of your soul every time you cash them.
I don’t know the answer – but there has to be a better way. What if I didn’t have family and friends? I weep for the future if all must bow down to an indifferent government just to get by.
I signed up with a noted primary physician. He’s part of the MDVIP program. You have to pay $1,500 up front per year. For that, however, you get a thorough physical, and if you get sick you get in to see him the same day. Plus, you have his cell phone. However, even if our health czar lets this practice continue, I feel certain that access to diagnostic, testing, hospital facilities will be rationed. It won’t matter if you can pay your doctor cash. We’ll all be in a line. Stay healthy.
A casual acquaintance of mine in the neighborhood is a physician, oncology, and is employed by a respected local hospital.
For years she has railed against private practice physicians, and their moneygrubbing ways. She is a HUGE supporter of ObamaCare. As smart as she is, and she is very smart, I can’t believe she’s falling for this con.