Insurance and Healthcare

[Kevin]

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

[KSig RC]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

While this is marginally likely, it seems like there is no "exchange" or any sort of market method for utilizing the increased competition.

I've toyed with the idea of starting a sort of "brokerage" for more common services, especially as more people move toward the "personal health savings account" model and will thus (hypothetically) have more control and interest in actual costs. This system would be incredibly useful to the consumer and to the doctor, but would really require a large break from current modes of interaction with payment devices (i.e. insurance) and doctors.

[bluefish81]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

How one plays a direct role with the other, I don't know. I was more trying to respond to the OP's question of my opinion of healthcare in the U.S. Whenever the idea of universal healthcare is brought up, opposition says we'll have to wait for hours and hours to get in to see our doctors because "that's what's happening in those countries with universal medicine." Um, clearly in some situations here, this is already the case. I imagine on both sides of the coin - here and in countries with universal healthcare it's all about where you live.

[bejazd]

[quote=Kevin;1593973]What part in the cost of health care does the scarcity of M.D.'s play?

The scarcity of MDs who want to work for minimal pay under crappy working conditions? A big part. Does the top med student out of our best medical school want to spend her career working in a clinic where they shuffle through patients every five minutes? I don't think so. We want our healthcare providers to be the best educated, best trained, most experienced professionals with access to all the best equipment, tests, and medications. We expect premium care from our health care providers, and we're going to have to pay them well and provide them with autonomy if we want a premium healthcare system.

[Kevin]

The scarcity of MDs who want to work for minimal pay under crappy working conditions? A big part. Does the top med student out of our best medical school want to spend her career working in a clinic where they shuffle through patients every five minutes?

That's just the thing -- to get into pretty much any med school, you need excellent grades and a pretty good MCAT score. If you were a mediocre student who scored well on the MCAT? You *might* get into DO school.

The fierce competition for a limited amount of admissions slots should (and this is not based on fact, observation, or anything but conjecture) breed the sort of M.D. who will expect to have an elite job with elite compensation whether they graduate from John Hopkins or anywhere else. Can anyone name a med school which has 'easy' entrance requirements or one which will admit students on a probationary basis?

I don't think so. We want our healthcare providers to be the best educated, best trained, most experienced professionals with access to all the best equipment, tests, and medications.

Why should medicine have to have only the "best"? How determinative are undergraduate grades and MCAT scores as to how good someone will perform in a family practice environment? We don't need every single person in the profession to be elite.

We expect premium care from our health care providers, and we're going to have to pay them well and provide them with autonomy if we want a premium healthcare system.

Sometimes, mediocre will suffice.

[bejazd]

I think we've got plenty of mediocre and flat out terrible practictioners out there. I don't think I want anyone who is mediocre diagnosing my child or prescribing medications, performing surgery etc. But I'm totally okay with a PA or a nurse under the direct supervision of an MD performing many of the routine tasks MDs do during regular office visits.

But...if I take my kid to the dermatologist, and he never sees the MD, is it right for the MDs office to charge me the same fee for an office visit as if he'd seen the MD? Even though the PA makes far less money?

[Kevin]

Originally Posted by bejazd

I think we've got plenty of mediocre and flat out terrible practictioners out there.

Which just goes to show you that the connection between academic performance in undergraduate college and performance in the medical field is very tenuous.

Really, other than M.D's being able to charge outrageous rates, who would be harmed by an influx of highly trained individuals into the profession?

Look at the law profession -- the wide open doors of law schools nationwide has made a lawyer something that you don't have to be wealthy to be able to afford.

That's good, right?

[AKA_Monet]

Originally Posted by Kevin

What part in the cost of health care does the scarcity of M.D.'s play?

It seems that the extremely restrictive enrollment criteria from med schools has really limited the number of doctors.

Could some serious public investment in new med schools or larger med schools help to alleviate some of our cost problems?

Kevin, VERY AWESOME QUESTION!!! Given I just got back from my State Legislature and some info on healthcare...

Physicians who have limited training cannot best treat their patients. It is different from other countries like China, where what they call MD's there are really PA-C here... They KNOW some aspects of medicine, but not all the aspects that are expected to pass the USMLE--all parts.

The enrollment is restrictive because there are so many people who want to be MDs. The other issue is there is something like ~300 med schools in the US--the one's that are accredited. Moreover, it is very expensive to fund certain specialties--like surgical wings-- pricey--and NO ONE will pay for students to screw up that on anyone... So most med students take on the "higher paying, easier (loosely used) pass" specialties, like family med, internal med, pediatrics, a few others. The hard ones, like cardiothoracic surgery... Wow, the school I worked for, cannot find many students interested... I'd do it if I could tie knots, but I cannot do it.

There is only one med school in my state. And it serves 4 other states with the pre-requisite of those students going back to their home states... That rarely occurs. Reasons are after one finishes med school, they go to do residency elsewhere in another location, that includes clinic duty. And if they like research, well they do that, too.

Who does the healthcare, ER surgeons do... But most of those doctors are triage folks. Many of ex-military or currently serve... A JAMA article just came out about their duties in Iraq and how to train for triage. But EVERYONE KNOWS that ER healthcare is NOT preventative--especially for chronic conditions... Good for blown limbs, BAD for chronic conditions du jour--unless there is a heart problem, priaprism or huristism...

And the sad part is, most of the American public uses ER care as their primary health care due to anger toward their primary care physicians. One has to be dead in their butts to get optimal care from an HMO, non-specialist... Even I had to do that. What's interesting about my HMO, is I write them emails and that crap gets into my medical record... So, if they deny me treatment, they might get put up under AMA board review... (hint, hint)