Tuesday, June 5, 2007

The most important issue in medicine

In my opinion the most important issue in medicine is the number of graduating medical students. Why? Because supply and demand determines the price of any good or service. Train too many doctors and reimbursements will decline. This has already been happening since the mid eighties! and it should NOT continue. The US are a better place to work for doctors than most European countries (and as a German I know this from my own personal experience), because someone was smart enough to freeze new medical schools.

Now we have a most unfortunate study trying to predict the future, which forsees a "physician shortage by 2020" and consequently university deans, eager fro the reputation, funds and power that come with a medical school, clamor to create new medical schools. In my humble opinion the author of this study resembles a "useful idiot" for the HMOs (remember that cold war term that so aptly described those people that supported communist ideas?)


Few people see it that way. Everybody seems busy with their everyday activities and misses the big picture. Any increase in the number of physicians is absolutley detrimental. Incomes will drop even faster than they have in the last twenty years. Did you enjoy that? Keep quiet about new medical schools! Did you like loosing income? Keep quiet about new medical schools!
Have trouble paying off your medical school debt? Just support new medical schools and more doctors! Have troble paying your mortgage? Just welcome new and more doctors!
Are you enjoying the power of HMOs? They will only get stronger the more doctors are around - they will always find someone who works for less!

We need less doctors, not more.

The latest issue of the American Medical News reports on the "burgeoning retail clinics". There is your competition that you did not see coming! There is your increase in health care providers and services that makes it unnecessary to train more doctors!

In Minnesota Blue Cross Blue Shield supported the opening of retail clinics and from 2004 to 2007 the number of visits increased from 9,800 to 33,800 and the charges per visit increased from 39.84 to 72.90! And you thought this was a minorthing and people would not go or would go only for insignificant issues!

Hey, those that went to a retail clinic seemed satisfied. In the same article a table shows that:
patients that were very / somewhat satisfied with quality of care - 90%, withhaving qualified staff - 85%, with convenience 83% and with cost 80%.

This is completely in line with physician practices! And you thought retail clinics were no competition?

Not only do we NOT have a physician shortage at this time, we have a physician oversupply. The oversupply will get much worse due to Internet medicine and retail clincs. HMOs will rejoice and their profits will grow, your income, my dear colleague, will shrink.
You have been warned.


The Independent Urologist said...

Yeh, I agree. But it is nothing new. When I was in med school, people were talking about a shortage of primary care docs, such as family practice, and consequently many students were persuaded to pursue those specialties and become "the gate keeper." Well you know what happened next. IM and FP are dime a dozen and get bargain basement reimbursements. Neurosurgeons, on the other hand, command high fees because there are so few of them and demand for their services are high. I also think your specialty has trained far too many residents as well. Urology trains ~220 per year, but like anything else, most urologist practice in big metro areas.
Anyway, good post.

ObGynThoughts said...

Thank you, Independent Urologist, for your thoughts. This time it is worse. There is a very unfortunate national push for more medical schools and more residency programs based on Dr. Richard Coopers attempts to foresee the future. It is the largest call for "more doctors" that we have had in 30 or so years. They are calling for 200K more doctor, a complete disaster. It completely neglects the fact that we had an oversupply, it falsely assumes that we have enough doctors at the present time. the report speculates on increased demand by baby boomers, even though they are healthier than any generation before, the report neglects any other supply of health care providers, such as nurse practitioners, midwives and PAs, it ignores the growing number of quick clinics - "you're sick, we're quick", it neglects the growing impact of telemedicine, the possibility of importing excellent physicians from e.g. Europe within a short time and others which I will go into in future blog posts.