Among the issues most commonly discussed are individuality, the rights of the individual, the limits of legitimate government, morality, history, economics, government policy, science, business, education, health care, energy, and man-made global warming evaluations. My posts are aimed at intelligent and rational individuals, whose comments are very welcome.

"No matter how vast your knowledge or how modest, it is your own mind that has to acquire it." Ayn Rand

"Observe that the 'haves' are those who have freedom, and that it is freedom that the 'have-nots' have not." Ayn Rand

"The virtue involved in helping those one loves is not 'selflessness' or 'sacrifice', but integrity." Ayn Rand

20 September 2009

Decreasing Number of Doctors with Increasing Health Care Demand

From 2003 to 2006, the number of doctors in the U.S. grew at a rate of 0.8% per year. That is an increase of 25,700 doctors per year. Meanwhile, the U.S. population grew at a rate of 1% per year. Patients are increasing at rates faster than doctors.

The Obama/Democrat Congress health care reform effort intends to increase the demand still further for doctors by inducing people without health insurance now to acquire it and use it. They also envision a major increase in such services as preventive care, which they claim will reduce overall medical expenses and therefore the use of doctor time. Medical studies show that preventive care actually costs more and uses more doctor time, however. In addition, the mandated insurance plans will require expanded coverage for many medical services, increasing still further the need for doctors and other medical service providers' services. Despite the inevitable increase in doctor and medical service provider services generally, Obama and henchmen claim that medical costs will come down. Hogwash. Obama and his anti-reality gang of socialist thugs cannot control the effects of supply and demand. They can take actions to increase demand and to decrease the supply with respect to doctors, however.

The U.S. already has only 2.4 doctors per 1,000 population. The median in the OECD nations is 3.1 doctors per 1,000. The Association of American Medical Colleges found that enrollment in medical schools has decreased steadily since 1980. With current health care demand, they found that there would be a 159,000 doctor shortage by 2025. This shortage is already the result of the very unpleasant environment in which doctors have to work with skyrocketing malpractice insurance costs, less than adequate Medicare and Medicaid reimbursement rates, and arbitrary second-guessing of physician decisions by government bureaucrats for Medicare, Medicaid, and other government health programs.

The Medicare Payment Advisory Commission says that the number of elderly Medicare patients who had trouble getting a primary care doctor to take them increased from 11% to 17% from 2004 to 2007. ObamaCare will greatly increase the present aggravations of having to deal with government as it gradually takes over the half of the industry it does not yet control.

Investor's Business Daily (IBD) polled 1,376 doctors to see what they thought of ObamaCare. 65% said they opposed it, while 33% supported it. Asked if seniors would get lower quality care under ObamaCare, 65% of the doctors polled agreed and 28% disagreed. Asked if ObamaCare was passed, would they consider leaving their practices or taking early retirement, 45% said they would and 5% gave no answer. This means 360,000 doctors will consider quitting or Going Galt!

Who can blame them? They will be saddled with more paperwork, which is almost no one's favorite pastime. In order to try to fulfill its promises of more affordable health care, the government will put more pressure on doctors to reduce their fees and to spend less time with patients, thereby reducing doctor rewards both in remuneration and in personal satisfaction with a job well-done. With more patients per hour, more mistakes will be made and the number of litigious patients will increase, both leading to still higher malpractice insurance rates. Doctors will be underpaid and more weary even than now. What a life!

Massachusetts began the ObamaCare experiment in 2006. So have Hawaii, Tennessee, and Maine done similar experiments. In all of these cases, expenses increased faster than the national norm and doctor shortages became worse. Services had to be cut back. That is, rationing always resulted.

The Massachusetts Medical Society just released a study that found that insurance premiums are rising at a rate 22% faster than the U.S. as a whole. The doctor shortage is worsening due to the poor practice environment in the state. Primary care specialties (family and internal medicine) are in short supply for the 4th year in a row. The fraction of primary care practices closed to new patients is the highest ever recorded. Doctors in the dermatology, neurology, urology, vascular surgery, obstetrics-gynecology, family and internal medicine are in short supply. Recruitment and retention of doctors is very difficult, especially in primary care and in community hospitals.

Overall health spending, rather than complying with Obama's wishes, is higher than in the U.S. on average and growing faster, according to the Urban Institute. Apparently, Obama's wishes and claims carry less weight than does the law of supply and demand. The IBD survey found that this reality was well-understood by many doctors. 71% of them said they did not believe that "the government can cover 47 million more people and that it will cost less money and the quality of care will be better." It just is not understood by Obama and the Democrat Congress who are determined to use the force of government to force us all into their medical care hell.

Some may say that the American Medical Association (AMA) is backing ObamaCare, so the doctors must be backing it. The AMA only represents 18% of doctors and it is losing those who are members in large numbers because of its backing.

Great Britain's National Health Service (NHS) has a severe shortage of doctors. One-third of primary care trusts are flying in general practitioners from other countries to help them with their overloads. They actually fly in doctors from Hungary, Italy, Lithuania, Poland, Germany, and Switzerland, according to the British Daily Mail. Many of their resident doctors are already immigrants trained in other countries, in even much larger numbers than is the case in the U.S. or Canada, whose nationalized health care system is not as old as is Britain's. The overworked British doctors refuse to see patients at night or on weekends.

Canadian doctors can fairly readily emigrate to the U.S. and have done so in large numbers. What else is to be expected as a response to rigid work rules and income limits in Canada? The law of supply and demand always works, no matter what some people may wish and choose to impose through the use of government force.

Above all else, above the shortages, the increased costs, and the rationing of medical care that results with government controls, I worry most about the quality of the people who will choose to become doctors under this new regime. The most dedicated to their profession, the most independent-minded, the most creative, the most moral young people will Go Galt on the profession of medicine by refusing ever to become doctors in the first place. Only those who are easily brainwashed with the Obama duty to serve mantra will enter the field of medicine. The advancement and the quality of medical care will suffer horribly as a result during the lifetime of our children and grandchildren.

Many good doctors today will Go Galt and many a prospective good doctor will Go Galt by choosing a profession less enslaved by government. All good professionals are looking to enjoy their profession. They have the ability to excel in many professions, so why not choose one they will enjoy? My own daughter, Kate, worked in hospitals while earning her dual undergraduate degrees in Biotechnology and Biomedical Science with a 4.0 GPA while taking one-third more credits than she needed to graduate in four years. She decided she did not like the way medical care was already practiced and decided not to go to medical school. If medical practice were free of the harm already done by heavy-handed governmental regulations, I believe the profession would have had great appeal for her. As it is, she made the right decision to Go Galt on the medical practice profession and she made it without my input.

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