Watching and listening to the news lately one would think that all of the troubles in healthcare can be solved either by having everyone purchase insurance coverage or finding a funding source and giving it to them. I find it remarkable that the most "brilliant" economists keep on missing one of the most important factors in health care delivery. Who is going to provide the care to all of the newly expanded health care rolls? They somehow have the mistaken belief that if one has a health insurance card all will be well.
Unfortunately, they have forgotten one very important factor. While our population ages and shifts into a larger and larger number of people who require ever greater care we have not had any significant growth in physicians in decades. There was a bump in medical school enrollment in the 80's but that group, which I am part of, is established and unlikely to significantly increase it's workload.
For the past 20 years the best and brightest have chosen fields like investment banking and computer engineering. These fields have had dramatically greater compensation growth. In fact in the past 10 years physician compensation has had virtually zero increase so relative to inflation the income has gone backwards. This insight has not been lost on the young men and women in college. So, while our population grows our number of graduating medical professionals are hardly keeping up.
I predict that in the next 3 to 5 years this issue will hit a break point. Those with an existing physician will start off doing fine but if you don't have a doctor caring for you it may be near impossible to find one. This has already started happening in the primary care fields but it will extend to specialty care as well. In addition, there is a large number of doctors 60 to 70 years old who have delayed retirement the last 5 years. But, as the economy rebounds the doctors who are near retirement will see their retirement investments grow and become large enough to allow them to retire. This will put a further strain on an already highly stressed system.
In fact, as this group of doctors goes in to retirement a large number of people will be looking to establish relationships with new physicians. But they will be in direct competition with a younger group of the aging population as well as newly insured. I predict that this will create a very interesting dynamic that hasn't occurred in the country in generations. We won't need to worry about death panels or insurance denials of care because a large number of people won't be able to make it into an office.
In fact, we will see a huge shift to using the emergency room as a site of primary care. This has already occurred for the uninsured and under insured population but this will become typical for most everyone. I predict that insurance companies will begin to aggressively recruit doctors to their panels. They will require exclusive agreements and will give special packages to the doctors to recruit them in. This will likely shift another segment of the population into the ER. These will be patients who no longer can see their doctor because he is a provider for only a finite number of insurances.
The state and federal governments will be faced with an unprecedented issue. How to provide care for literally millions of people. We might look to recruiting doctors from overseas but as the economies in Asia begin to grow I suspect the doctors will sense opportunities for success in their homelands and will choose to avoid the chaos here.
Is there an answer? I doubt that there will be any easy way to solve this but I will begin to offer some ideas in my next blog "Slaying the Beast".
Why has business become so sexy while being a doctor has become less appealing? My guess is the rising cost of college, the decline in science (nationwide this is an issue - I'm often asked to teach less science in favor of more reading and writing) have both played a role in this decline. Students are neither familiar with the profession or able to handle the reality of a decade's worth of college just to begin a career.
ReplyDeleteI see a number of former students choosing to go to college based purely upon economic rather than social norms. Perhaps it's because they are immigrants and saw the reality of their parents' struggles. Or maybe it's that, being in an economic downturn, they feel the pinch a little harder.
Either way, many of the students who would have been passionate, motivated and compassionate as doctors are choosing a path that is quicker and potentially promises less debt and more security. Students realize that the cost of schooling is increasing while the relative pay is on the decline.
By the way, I love the line: "We won't need to worry about death panels or insurance denials of care because a large number of people won't be able to make it into an office."
Daniel: You explain it very clearly, however I do not hear similar logic conclusions coming from our societies/specialty colleges/associations, perhaps because they are already "bought" and do not care anymore about the welfare of the "provider". If the provider (label that I think make doctors more like salepersons or distributors of goods) is not healthy in all respects I believe the care they give will progressively deteriorate. Additionally I did not expect any intelligent analysis of this part of health care by the so call Journalists (by the way they get paid millions).
ReplyDeleteMiguel Vasquez, MD.