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21 March 2010

Doctors and the ObamaCare Shortage

The Medicus Firm, a national physician search firm based in Dallas and Atlanta, polled physicians about ObamaCare and its effects on them.  They reported the results in the New England Journal of Medicine.  Key results include:
  • 62.7% of doctors believe health reform is needed, but want targeted and gradual legislation, not the massive ObamaCare bill.
  • 46.3% of primary care physicians (family and internal medicine disciplines) believe ObamaCare will either force them out of practice or make them want to leave medicine.
  • 72% of doctors believe a public option will have a negative impact on medical care.
According to the Health Resources and Services Administration of the Dept. of Health and Human Services, there were 306,100 primary care physicians in 2005 and there were 511,400 Non-Primary Care specialist physicians in 2005, for a total of 817,500.  ObamaCare will depend upon these physicians to deliver the increased medical care that ObamaCare is supposed to provide to 32,000,000 more people.  About 15,000,000 of these people are expected to be added to Medicaid, which is a program a great many physicians will not participate in now or will not accept new patients from that program.  Who does this tyrannical Democrat government think will provide these services?  Many physicians are already also declining Medicare patients, though that program has paid somewhat better than has the Medicaid program.  However, the scheduled cuts in Medicare payments even as more and more Baby Boomers will soon enter it and need more medical care must surely cause the Medicare program to shift even deeper into underpaying doctors for their services.  The huge deficit growth of the federal government must further push it to making still lower Medicare and Medicaid payments to doctors.  The terrible condition of many state governments will also decrease their ability to make their expected and required Medicaid payments.

The net result is obvious, unless you are a pig-headed, pie-in-the-sky, other-worldly Democrat!  Doctors are going to be very unhappy.  Probably more than they now think even, as the reality of these much lower payments set in, as the tangle of myriad federal agencies start giving the doctors incredible increases in paperwork and contradictory requirements, as the number of unhappy patients pile up in their waiting rooms, and as the reality of having even less time per patient than the already inadequate time now causes them to lose all confidence that they are able to do their work in a manner consistent with professional standards, they will become seriously depressed.

When their work comes to be the source of depression, many will leave the profession.  The claim that 46.3% primary care physicians will do so or will be unhappy should be taken very seriously.  Many physicians will retire early.  In fact, there is clear evidence that many have already been unhappy enough with the pre-Obama
Care medical profession that they have been retiring early already.  We can learn more by looking at the age distribution of physicians according to the Health Resources and Services Administration.

First, note that despite the growing population of the U.S. from 2000 to 2010, the number of physicians in the three younger of the five categories dropped.  This trend is expected to be the case in 2020 also.  The only age group of doctors with an increase from 2000 to 2010 is the 55 to 64 year old group.  These doctors are close enough to retirement age and probably largely well enough off, that they can readily retire if ObamaCare is passed later today, as it now appears it likely will be.  Many of these doctors will indeed retire early and that means they will not be practicing in the 65+ age category either in the near future.  Many of the doctors already in the 65+ age group will quite immediately.

Now let us look into the future to the 2010 projection.  Note that the projection is rather optimistically expecting the future number of physicians in the 55 - 64 age group to remain as high as it is now.  This would mean a larger fraction of those in the 45 - 54 age group will continue on into the next age group than did in the 2010 case.  Given the effects of ObamaCare, this will surely not be the case.  This number will drop considerably relative to the prediction here.  It will also be insane to believe that a larger fraction of doctors will continue to practice after age 65 than did in 2000 and 2010 after ObamaCare comes into play.

The bad news does not end here.  There is another contribution to decreasing services which we are facing even without ObamaCare, which is going to make ObamaCare much less supportable.  To quote the Health Resources and Services Administration:
Currently, one in four physicians is female, but two factors are contributing to a rise in female representation. First, during the past three decades the proportion of new medical graduates who are female has risen from 10 percent to close to 50 percent. Second, the growth in female representation is a relatively recent phenomenon, and it is predominantly male physicians who are nearing retirement age. Although one in three active male physicians is age 55 or older, only one in eight active female physicians is age 55 or older. Because work and retirement patterns differ systematically for male and female physicians, the increasing proportion of physicians who are female has profound implications for the overall supply of physician services. Female physicians are more likely than their male counterparts to choose non-surgical specialties and to spend fewer hours per year providing patient care. They are also less likely to work in rural areas, and they tend to retire slightly earlier.
So, the increasing shift to more female physicians was going to lead to a smaller supply of medical services in any case.  Now, ObamaCare will chase more doctors out of the profession on top of the smaller numbers of younger physicians already and the larger fraction of female physicians who will work shorter hours and retire earlier.  This smaller pool of available physician manhours will be deluged by much more demand from aging Baby Boomers and from the greater demand brought on by ObamaCare.  The consequence will be that the quality of health care must degrade rapidly.  It will also become much more expensive, or degrade still more rapidly.  The law of supply and demand can never be denied.

We were already staring severe problems in the face.  ObamaCare is clearly going to make those severe problems catastrophic problems.  It will not be long before we really will have to be pulling the plug on granny much earlier than we have in the past.  Obama lied about this again just yesterday.  A lot of Baby Boomers are soon going to be very expendable.  Severe health care rationing is coming.  It probably was coming to some extent anyway due to the Medicare and Medicaid programs and the Baby Boomer demand increase, but ObamaCare will have to make this much more severe.  This will not be because anyone really wants this, except Obama and the Emanuel brothers, but because the Democrats do not think anything through and do not care about the constraints of reality.  They are simply other-worldly people.

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