[E]xpanding coverage cannot succeed as long as there remains a shortage of primary care clinicians.
Are you comfortable with the implications of this criticism? Are you willing to end the discussion there? To me it raises far more questions than it answers.
Ending the conversation there says that 1) wealth-based rationing is currently happening and 2) some sort of rationing has to happen. In other words, since we, as a country, can’t bother to find a way to get enough doctors to take care of our populace, we should be thankful that some people have been priced out of medical care. Shouldn’t this horrify us? We have a limited and critical resource and distribute it based on wealth rather than need?
Giving up should not be our response to a shortage. If the crops have a bad year and somebody announced that we can’t feed everybody, so we’ll have to let 30 or 40 million people starve, we wouldn’t sit back complacently and say, “I guess there’s nothing to be done.” We would do something about the shortage.
So why not do something about the doctor shortages? Give scholarships for medical schools. Consider whether we can use nurse practitioners more efficiently. Sort out what causes premed and med school burnout and whether anything can be done to prevent it without compromising quality. Build some new medical schools. Add a unit on medicine to some highschool honors classes so students who might have a spark can get some exposure to the issues. Create a medical program for college graduates without a premed background. Offer full scholarships and a small stipend. Attract some people who majored in math or physics or psychology but don’t want to make a career of it. Tack a year onto the beginning where students can learn some of the things they would have learned had they followed a rigorous premed path.
If we’re about to boost the demand for primary care clinicians, we can easily increase the supply of doctors.
This may have been true twenty years ago, but it is absolutely 100% false on multiple levels today. Nobody has been talking about this for 20 years. And now all of a sudden it’s an issue. Of course! There has been a systematic, carefully architected devaluation of primary care spearheaded by the AMA and sanctioned by the federal government for the past 20 years.
No doctors want to go into a profession with such horrible pay and work hours when a nice cushy job exist like radiology, anethesiology, dermatology, and any other “ology” out there that pays 3 times as much on average as primary care. Where are we going to get these doctors? Literally, the only way we can have more primary care doctors is through a massive federal initiative to recruit foreign doctors, much like we recruited massive numbers of nurses from the Philippines and other areas in the past decade.
However, what do you think will happen to the health of those nations if tens of thousands of physicians leave a poor country to come to the land of opportunity?
I hate to even think of that and how shameful that would make us look if children in a country that’s been working it’s ass off to boost up public health can’t find doctors to take care of their population because they’re all getting fat and rich in the US of A.
The AMA has represented specialists’ greed for 20 years and the feds have listened to them. There has not been a single policy put in place in the past 20 years when we knew there would be a horrible, horrible crisis that’s now just coming to a head.
Unfortunately, sometimes you just have to say “Damn, we fucked up.” And pay the consequences.
The only thing that will give me complete satisfaction is when specialists who thought they were going in to cushy positions with massive pay have to bring themselves down to the level of the “lowly” primary care doctor and start having to accept primary care-level payments because that’s better than sitting around doing nothing with all of the other specialists looking for patients.
Unfortunately, that won’t happen. We have the AMA sleeping with the entire beltway.
Here’s the kicker. The business that creates carefully architected virtual primary care delivery units that consist of nurse practitioners, physician assistants, nurses, and primary care doctors that can deliver primary care to a population of people at half that price of what it’s currently costing will be the most successful company in the next decade. It’s a $2,500,000,000,000.00 market. That’s a lotta money.