Thursday, March 03, 2005

So ... those sob stories we hear all the time about little towns where you just can't find a doctor anymore? That's all the fault of greedy trial lawyers with their junk medical lawsuits -- right?

Maybe not, as USA Today reports:

The country needs to train 3,000 to 10,000 more physicians a year -- up from the current 25,000 -- to meet the growing medical needs of an aging, wealthy nation, ... studies say. Because it takes 10 years to train a doctor, the nation will have a shortage of 85,000 to 200,000 doctors in 2020 unless action is taken soon.

... For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the
Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

"It didn't happen," says Harvard University medical professor David Blumenthal, author of a
New England Journal of Medicine article on the doctor supply. "Physicians aren't driving taxis. In fact, we're all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers."

The nation now has about 800,000 active physicians, up from 500,000 20 years ago. They've been kept busy by a growing population and new procedures ranging from heart stents to liposuction.

We have a doctor shortage, in other words, because a conscious choice was made to keep the number of doctors in America at this level, based on an assessment of need that we now know is wrong.

The AMA was a bit slow on the uptake -- the article notes that

Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

In fact, that position was held by the AMA as recently as two years ago.

And note that the government sets the pace of medical training:

Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors....

The government spends about $11 billion annually on 100,000 medical residents, or roughly $110,000 per resident. The number of residents has hovered at this level for the past decade, according to the Accreditation Council for Graduate Medical Education.

In 1997, to save money and prevent a doctor glut, Congress capped the number of residents that Medicare will pay for at about 80,000 a year. Another 20,000 residents are financed by the Veterans Administration and Medicaid, the state-federal health care program for the poor. Teaching hospitals pay for a small number of residents without government assistance.

Medicare, which faces enormous financial pressure in coming decades, already spends 3% of its budget training physicians and may not have the resources to spend more....

Oh, and doctors, perhaps understandably, tend to set up practices where they'd like to be rather than where the need is, and in high-paying specialties, again regardless of what's really needed. And modern doctors practice fewer hours than doctors did a few years ago.

I'm not saying that the cost of malpractice insurance is 100% irrelevant to the doctor shortage. But these seem to be the major reasons that the sleepy little towns Republicans love to cite really don't have enough doctors.

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