Honest question about the physician shortage

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Im guessing you've been removed from the residency app process for a while now, there are only a couple hundred spots, if that, left after the SOAP
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I was imprecise. There are thousands more slots than can be filled by US medical students. These positions are in primary care and surg prelim.

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So if we take the average number of PGY-1 positions to be 29,000, then 100% capacity would be about 33,000 spots. Since that's an average, if primary care residencies are at less than 90% capacity, then the "extra" spots would disproportionately go to them. There would still be a massive shortage of physicians, which means that the only way to solve the problem would be to create more teaching hospitals/expand programs.
Hospitals are closing, not opening. Inpatient care isn't as profitable as it used to be and it's getting less profitable all the time. Only one hospital in my entire state runs consistently in the black, to give you an idea. We can't just open multi-million (and even multi-billion) dollar hospitals just to train doctors when we've found that outpatient and home care are viable alternatives that save money. The federal government struggles with the idea of paying even 100k/year per resident, they're not exactly going to be thrilled to pay millions more on top of that to build hospitals, hire nurses, etc etc.
 
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but market supply and demand forces will force more people into primary care. You've just finished medical school and don't have the stats, etc. to match into the competitive specialties - do you just call it quits and go flip burgers? Or do you try to match into a program that is less competitive and now has more slots?

The million dollar assumption here. First we are assuming someone has finished med school and has no other option; if we are talking about the future this will tank the amount of people applying to med school. It will lead to an even more cut throat environment as now the race isnt just to get your speciality, its to not be the lowest 50% so you wont be primary care.

Not to mention the mental health epidemic when you are forced into primary care.
 
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Hospitals are closing, not opening. Inpatient care isn't as profitable as it used to be and it's getting less profitable all the time. Only one hospital in my entire state runs consistently in the black, to give you an idea. We can't just open multi-million (and even multi-billion) dollar hospitals just to train doctors when we've found that outpatient and home care are viable alternatives that save money. The federal government struggles with the idea of paying even 100k/year per resident, they're not exactly going to be thrilled to pay millions more on top of that to build hospitals, hire nurses, etc etc.

If the future of the practice of medicine is heading towards outpatient and home care, then why not alter the way we train physicians then? If the "physician shortage" reflects a demand not for inpatient care but rather for outpatient and home care, then why not train residents precisely in those settings, where they will eventually be practicing?

Whatever the training programs we need, they needn't all be federal government-funded. I think there is a lot of red tape involved here but if inpatient care is also opened up to the level of private capital that other rapidly-growing sectors of the economy have access to, wouldn't that help to alleviate the issue, since residents do bring in a lot of revenue for hospitals at a cheap cost of labor?
 
The million dollar assumption here. First we are assuming someone has finished med school and has no other option; if we are talking about the future this will tank the amount of people applying to med school. It will lead to an even more cut throat environment as now the race isnt just to get your speciality, its to not be the lowest 50% so you wont be primary care.

Then it needs to begin before medical school. That's why many schools have these sorts of primary care programs to funnel students into these disciplines, like the Primary Care Scholars program at Mount Sinai. Not to mention you can also get loan forgiveness for working in underserved areas in a primary care discipline.
 
you can also get loan forgiveness for working in underserved areas in a primary care discipline.

This already occurs and people dont want to do primary care.

Money isnt the reason people dont like the field. Its because it sucks. Its mundane crap day after day after day for 60 years. I spent 1 year in a primary care practice and I got out as soon as my funds allowed me to take a position in an ED.
 
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This already occurs and people dont want to do primary care.

Money isnt the reason people dont like the field. Its because it sucks. Its mundane crap day after day after day for 60 years. I spent 1 year in a primary care practice and I got out as soon as my funds allowed me to take a position in an ED.

"People don't want to do primary care" is an unwarranted, sweeping statement. I would agree that many, many people don't want to do primary care but there are many people who also do want to do primary care for one reason or another. For the same reason why one person could never imagine getting an MD and not practicing while another might see an MD as a means to a lucrative McKinsey position that compensates well without the threat of medical malpractice.

Are you talking about a patient care tech position, phlebotomist, etc.?
 
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Then it needs to begin before medical school. That's why many schools have these sorts of primary care programs to funnel students into these disciplines, like the Primary Care Scholars program at Mount Sinai. Not to mention you can also get loan forgiveness for working in underserved areas in a primary care discipline.

Not that I know anything, but I've always wondered what would happen if the loan forgiveness logic were extended. What if the government (or some public-private partnership) guaranteed high salaries for doing primary care in these areas? If the government were guaranteeing competitive benefits, malpractice protection and a minimum $350k salary to practice primary care in rural Kentucky, wouldn't market forces drive primary care docs there?

I get that it's not a completely free market and that many people will just never want to go to the middle of nowhere, but... I've always wondered if this kind of thing is a solution to the physician distribution issue.
 
Not that I know anything, but I've always wondered what would happen if the loan forgiveness logic were extended. What if the government (or some public-private partnership) guaranteed high salaries for doing primary care in these areas? If the government were guaranteeing competitive benefits, malpractice protection and a minimum $350k salary to practice primary care in rural Kentucky, wouldn't market forces drive primary care docs there?

I get that it's not a completely free market and that many people will just never want to go to the middle of nowhere, but... I've always wondered if this kind of thing is a solution to the physician distribution issue.

I think a government subsidy on physician wages would help with the distribution problem - whether people want to go to the middle of nowhere shouldn't factor into the economic analysis because presumably, that's factored into the supply of labor curve. Some people might live in Kentucky and so would work there for only a relatively small wage whereas somebody who has never lived in small-town USA might demand a larger wage to move out to the middle of nowhere. That's all factored into the upward-rising supply curve.
 
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There are already thousands of unfilled residency spots in primary care. There are only going to be more of them after the merge.
I was referring to non-primary care spots.
 
Some people might live in Kentucky and so would work there for only a relatively small wage whereas somebody who has never lived in small-town USA might demand a larger wage to move out to the middle of nowhere. That's all factored into the upward-rising supply curve.

I think the problem with this is that disproportionately fewer people from rural areas get to medical school. A lot of people decide to become doctors because of someone they know, so if there is very few or none doctors in one's hometown they are less likely to choose this career path in the first place. Rural areas also lack private prep schools, magnet schools, etc. that produce a disproportionate amount of premeds and eventual medical students. Even medschools with rural missions will find it difficult to take a person from a rural area that struggled the first few years because their high school didn't prepare them for college when they have thousands of applicants with near perfect GPAs and a wealth of clinical experience accumulated over breaks from cities.

And then, if a person from a rural area does get to medical school, they will spend about a decade between medical school, residency and possibly undergrad living in or near a city and might decide that they prefer living in a city. The opposite almost never happens.
 
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I think the problem with this is that disproportionately fewer people from rural areas get to medical school. A lot of people decide to become doctors because of someone they know, so if there is very few or none doctors in one's hometown they are less likely to choose this career path in the first place. Rural areas also lack private prep schools, magnet schools, etc. that produce a disproportionate amount of premeds and eventual medical students. Even medschools with rural missions will find it difficult to take a person from a rural area that struggled the first few years because their high school didn't prepare them for college when they have thousands of applicants with near perfect GPAs and a wealth of clinical experience accumulated over breaks from cities.

The people who want to live in rural areas don't have to be from rural areas originally. Individual preferences are also inherently factored into the construction of any supply curve. If there really is a general, objective preference for urban areas regardless of a person's background, then the supply curve would simply be shifted to the left and a higher market price would be demanded for work in the rural area. A government subsidy on wage would still work the same way, albeit the subsidy would need to be higher to meet the demand. The main problem with a subsidy is that our government has severe budgetary issues. We all disagree on how to address those issues, what programs to cut, etc. but the fact of the matter is those issues exist. Any politician who comes out and says they're introducing a bill that subsidizes physician wages is not going to be very popular among his or her constituents.
 
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The people who want to live in rural areas don't have to be from rural areas originally. Individual preferences are also inherently factored into the construction of any supply curve. If there really is a general, objective preference for urban areas regardless of a person's background, then the supply curve would simply be shifted to the left and a higher market price would be demanded for work in the rural area. A government subsidy on wage would still work the same way, albeit the subsidy would need to be higher to meet the demand. The main problem with a subsidy is that our government has severe budgetary issues. We all disagree on how to address those issues, what programs to cut, etc. but the fact of the matter is those issues exist. Any politician who comes out and says they're introducing a bill that subsidizes physician wages is not going to be very popular among his or her constituents.

You keep talking supply curves but ignore reality. There HAS been efforts to improve the prospects of primary care. There ALREADY exists loan forgiveness. People do not want to do primary care. I am not "tooting my horn" here, but I may get into a top 20. I would simply not even become a doctor if I knew there was a 50% shot I would end up in primary care.

The ONLY way I can support what you are proposing is if you open seats up. Tell the matriculant up front that they are only allowed to apply to family medicine residencies. That way, people who actually got into the medical school straight up are allowed to learn in a non-cut throat environment where everyone is not competing to not be a PCP.
 
If the future of the practice of medicine is heading towards outpatient and home care, then why not alter the way we train physicians then? If the "physician shortage" reflects a demand not for inpatient care but rather for outpatient and home care, then why not train residents precisely in those settings, where they will eventually be practicing?

Whatever the training programs we need, they needn't all be federal government-funded. I think there is a lot of red tape involved here but if inpatient care is also opened up to the level of private capital that other rapidly-growing sectors of the economy have access to, wouldn't that help to alleviate the issue, since residents do bring in a lot of revenue for hospitals at a cheap cost of labor?
Well, I hate to tell you this... But there is no shortage.

A Doctor Shortage? Let’s Take a Closer Look

We shouldn't be opening many more residencies because there really isn't much need. We have a misallocation problem, not a shortage.
 
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You keep talking supply curves but ignore reality. There HAS been efforts to improve the prospects of primary care. There ALREADY exists loan forgiveness. People do not want to do primary care. I am not "tooting my horn" here, but I may get into a top 20. I would simply not even become a doctor if I knew there was a 50% shot I would end up in primary care.

I don't think you understand supply curves as much as you think you do. All those things do exist at varying levels. Loan forgiveness programs are pretty small and the first graduates from the federal med school loan forgiveness program for service in underserved areas are just now coming off the program. There are also many problems with that program that screw over many people who check all the boxes but find out that they are no longer eligible after ten years on a technicality. Someone mentioned wage subsidies for primary care, which I think is a good idea, if a little outside within current budgetary constraints. Not sure what mentioning that you "may" get into a top 20 school achieves here especially since IIs for the current cycle haven't even gone out yet. I would really suggest not counting your chickens. But I met people with very diverse interests at the top 20 schools I interviewed at and many indeed want to go into primary care. Not necessarily family practice but other primary care disciplines like peds, ob/gyn, etc. Just because you have your own tastes and preferences doesn't mean that everybody else has to share them too.

The ONLY way I can support what you are proposing is if you open seats up. Tell the matriculant up front that they are only allowed to apply to family medicine residencies. That way, people who actually got into the medical school straight up are allowed to learn in a non-cut throat environment where everyone is not competing to not be a PCP.

There would be no way to enforce that, not to mention the fact that many if not most medical school matriculants have no idea what they want to do. They may find an interest in neurosurgery during medical school but at the outset, they're not all dead set against primary care disciplines.
 
Then it needs to begin before medical school. That's why many schools have these sorts of primary care programs to funnel students into these disciplines, like the Primary Care Scholars program at Mount Sinai. Not to mention you can also get loan forgiveness for working in underserved areas in a primary care discipline.
This is a poor solution- physician training shouldn't be tracked early on, as interests change over time and it really screws a lot of people over that have very different ideas as they age.
 
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Well, I hate to tell you this... But there is no shortage.

A Doctor Shortage? Let’s Take a Closer Look

We shouldn't be opening many more residencies because there really isn't much need. We have a misallocation problem, not a shortage.

I remember seeing that article - the problem then becomes not expanding residency programs but rather directing future doctors towards practicing in underserved areas. Which obviously then makes the whole discussion about residency expansion/capacity moot.
 
You keep talking supply curves but ignore reality. There HAS been efforts to improve the prospects of primary care. There ALREADY exists loan forgiveness. People do not want to do primary care. I am not "tooting my horn" here, but I may get into a top 20. I would simply not even become a doctor if I knew there was a 50% shot I would end up in primary care.

The ONLY way I can support what you are proposing is if you open seats up. Tell the matriculant up front that they are only allowed to apply to family medicine residencies. That way, people who actually got into the medical school straight up are allowed to learn in a non-cut throat environment where everyone is not competing to not be a PCP.
Um, that is ridiculous. You're basically calling for two-tier medical education where people are tracked into "have" and "have not" positions right off the bat, simply to protect the "haves." I've also known plenty of people over the years that went into medical school with your attitude and bombed the boards, leaving them dissatisfied with their future prospects, so tread lightly, work hard, and don't take anything as a given or you'll end up like many of the people that I've known that wanted to be surgeons and ended up in FM, IM, or any number of other fields that they viewed as undesirable.
 
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I remember seeing that article - the problem then becomes not expanding residency programs but rather directing future doctors towards practicing in underserved areas. Which obviously then makes the whole discussion about residency expansion/capacity moot.
I mean, personally I've always found it to be moot, but for the people that want to believe in the "physician shortage," I'm always willing to half-assedly discuss it.
 
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This is a poor solution- physician training shouldn't be tracked early on, as interests change over time and it really screws a lot of people over that have very different ideas as they age.

Tracking physician training is not the same as mandating that students must follow a particular path. Someone else suggested that. I'm merely suggesting that students get greater exposure to primary care disciplines so that they can make a fully informed decision without succumbing to the general "stigma" of primary care disciplines as being undesired and the bottom of the profession. It's the equivalent of getting people not to judge a book by its cover. It's the same thing that STEM programs do - we do REUs and research programs for underrepresented minorities and women not to force them into STEM but to give them exposure to it so they can make an informed decision about whether to go into STEM fields, which are also stigmatized.
 
Tracking physician training is not the same as mandating that students must follow a particular path. Someone else suggested that. I'm merely suggesting that students get greater exposure to primary care disciplines so that they can make a fully informed decision without succumbing to the general "stigma" of primary care disciplines as being undesired and the bottom of the profession. It's the equivalent of getting people not to judge a book by its cover. It's the same thing that STEM programs do - we do REUs and research programs for underrepresented minorities and women not to force them into STEM but to give them exposure to it so they can make an informed decision about whether to go into STEM fields, which are also stigmatized.
That guy was suggesting actually tracking them into PC so that it would decrease the competitiveness within medical school classes as people fight to not end up in PC, which is a dumb, stupid, terrible idea.
 
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I think the problem with this is that disproportionately fewer people from rural areas get to medical school. A lot of people decide to become doctors because of someone they know, so if there is very few or none doctors in one's hometown they are less likely to choose this career path in the first place. Rural areas also lack private prep schools, magnet schools, etc. that produce a disproportionate amount of premeds and eventual medical students. Even medschools with rural missions will find it difficult to take a person from a rural area that struggled the first few years because their high school didn't prepare them for college when they have thousands of applicants with near perfect GPAs and a wealth of clinical experience accumulated over breaks from cities.

And then, if a person from a rural area does get to medical school, they will spend about a decade between medical school, residency and possibly undergrad living in or near a city and might decide that they prefer living in a city. The opposite almost never happens.


Your entire post is spot on, especially the part about never wanting to go back to a rural location. I grew up rural, there were a few positives, but honestly the lack of resources negatively affect the quality of life. I hope I never have to go back there.
 
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Medical College of Wisconsin is betting that some prospective students will sign up for their satellite campuses that pretty much limit your training (over 3 years with no breaks) to family medicine, gen surg, psych or OB. The point is to choose people who want to stay in the rural parts of the state. Maybe they will attract students who are "good enough" to successfully complete medical school and who will be happy to practice in underserved parts of the state... I'd rather see applicants with lower stats and a desire to practice in small towns to go to these seats than to openl more seats in urban schools with high fliers who want to practice neurosurgery or dermatology in a big city.
 
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Medical College of Wisconsin is betting that some prospective students will sign up for their satellite campuses that pretty much limit your training (over 3 years with no breaks) to family medicine, gen surg, psych or OB. The point is to choose people who want to stay in the rural parts of the state. Maybe they will attract students who are "good enough" to successfully complete medical school and who will be happy to practice in underserved parts of the state... I'd rather see applicants with lower stats and a desire to practice in small towns to go to these seats than to openl more seats in urban schools with high fliers who want to practice neurosurgery or dermatology in a big city.
The trouble with this, to me, is that many of these students might change their minds along the way, and find themselves in a box that they no longer want to be in. It's easy to say, "well, too bad, that's what you signed up for," but people change, as do their desires, interests, and what they want out of life. Very, very few people I know that started medical school wanting to do primary care still want to do it (though many are being forced down that path because of boards etc).
 
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The trouble with this, to me, is that many of these students might change their minds along the way, and find themselves in a box that they no longer want to be in. It's easy to say, "well, too bad, that's what you signed up for," but people change, as do their desires, interests, and what they want out of life. Very, very few people I know that started medical school wanting to do primary care still want to do it (though many are being forced down that path because of boards etc).

Well, anyone who enters a profession might decide that it is not what they want. Some people change careers at an advanced age but not others just live with the mistake they made. Very few people leave medical school although some do.
 
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Well, anyone who enters a profession might decide that it is not what they want. Some people change careers at an advanced age but not others just live with the mistake they made. Very few people leave medical school although some do.
Given the sacrifice of medical school, it is not merely a "career path." It is virtually a prison, beyond a certain point, so I'd prefer it remain a prison with choices. There is no other profession in this country that demands the sacrifice of medicine while offering so few ways to escape, save for perhaps the military, but we are civilians, so their plight need not apply to us.
 
Given the sacrifice of medical school, it is not merely a "career path." It is virtually a prison, beyond a certain point, so I'd prefer it remain a prison with choices.
This is very encouraging to those considering the field. That's the mindset pre-meds should have so that the shortage, maldistribution, whatever you want to call it, is resolved.
 
This is very encouraging to those considering the field. That's the mindset pre-meds should have so that the shortage, maldistribution, whatever you want to call it, is resolved.
It's the truth. If I'm going to be in a cage of 400k in debt, I'd better at least have the option of working my way up to a gilded cage if I put in the effort.
 
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Well, anyone who enters a profession might decide that it is not what they want. Some people change careers at an advanced age but not others just live with the mistake they made. Very few people leave medical school although some do.

So are you saying as a compromise for letting rural students in with lower stats, its fair ( and ethical) to contractually trap them and limit them to primary care even if they find out later its not what they want to do? Then again, their is no way you can actually trap a student into primary care, if you give them scholarships to pursue primary care they can repay you and if at the end of 3rd year they are competitive for another specialty, they apply to whatever they want. I don't know its legal for a school to limit what type of residency a student can apply to.
 
This is very encouraging to those considering the field. That's the mindset pre-meds should have so that the shortage, maldistribution, whatever you want to call it, is resolved.


The thing about being premed is you guys just don't realize how much med school sucks. Yes even with the promise of a 250k+ job after you get out, the process sucks so much you still wish you could quit at times. Med school isn't premed number 2 where you can do well and still have a social life, even the best students are constantly stressed out and sleep deprived to a much greater level than undergrad.
 
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Exactly. You can't have a socialized system coexist with a privatized one and expect the doctors to take the lower-paying government reimbursements just for the hell of it if they have plenty of other clients who'll pay more for their time.
False. This exists in Spain and Canada.

Also, a single payer system is not socialized medicine. Its a midway compromise.

Socialized Medicine Examples:
-NHS (UK)
-VA (USA)

Mixed System (Single Payer):
-Medi-Cal/Medicare (kinda)
-Canadian Healthcare System
 
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It's the truth. If I'm going to be in a cage of 400k in debt, I'd better at least have the option of working my way up to a gilded cage if I put in the effort.

In this reality you are in a cage of 400k debt except now you hypothetically expand the med school class size and increase the primary care residency positions; and now a class of 400 has to battle for 100 non-primary care seats. Its even worse than the race that already exists to not be primary care.

Like I said. My entering medical school is essentially "what are my chances of being a doctor that isnt family med". Anything that endangers that should be opposed.
 
In this reality you are in a cage of 400k debt except now you hypothetically expand the med school class size and increase the primary care residency positions; and now a class of 400 has to battle for 100 non-primary care seats. Its even worse than the race that already exists to not be primary care.

Like I said. My entering medical school is essentially "what are my chances of being a doctor that isnt family med". Anything that endangers that should be opposed.
The game as it is now functions well enough. Those who aren't good enough to match specialties end up in primary care. They're not forced into it, they have every opportunity to work hard and end up elsewhere.
 
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Mid-levels providing primary care or medical schools training medical students who will be limited in the residency positions they can choose to family medicine, gen surg, psych or OB.

Which is better for prospective health care providers and which is better for underserved communities?

I don't have an answer, I'm interested in your perspectives on solving the maldistribution/shortage.
 
The game as it is now functions well enough. Those who aren't good enough to match specialties end up in primary care. They're not forced into it, they have every opportunity to work hard and end up elsewhere.


Right now "not being good enough" is being in the lowest 30%. In your world its now being in the lowest ....50%? 70%? etc.
 
Right now "not being good enough" is being in the lowest 30%. In your world its now being in the lowest ....50%? 70%? etc.

I don't think his "world" involves expanding the medical school class size at all, since his perspective is that it's a physician allocation problem and not a shortage problem.
 
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I don't think his "world" involves expanding the medical school class size at all, since his perspective is that it's a physician allocation problem and not a shortage problem.

I am replying to you then I think. I wasn't looking at who the user was closely enough.
 
I am replying to you then I think. I wasn't looking at who the user was closely enough.

Well, if tracking future physicians is a bad idea without expanding medical school class sizes, it's still a bad idea after expanding medical school class sizes. If you expand medical school class sizes and primary care residency spots (without expanding other residency spots), it is true that competitive residencies may get more competitive, assuming the newly added students (and I'm not talking about a four-fold increase in class size here) have similar strengths and tastes as the other students. But in the end, it will still be the top students who get what they want. The other students will still go into primary care for whatever reasons - either they wanted to in the first place (a non-negligible population) or they don't have the scores, etc. to get into the top residencies. So in other words, it'll be what we have now, just slightly (again, we're not increasing a class size multi-fold - just a ramping up to, say, 20% higher than now) more competitive and more physicians graduating.

I don't think your characterization of medical school classes as a race to get away from primary care disciplines is accurate. Again, many of my future classmates and people I met on the interview trail wanted to do primary care. They wanted to go into peds, into ob/gyn, into psychiatry, etc. We're talking about people's passions here. Not everybody is driven solely by money and lifestyle (although those do play a factor).
 
Mid-levels providing primary care or medical schools training medical students who will be limited in the residency positions they can choose to family medicine, gen surg, psych or OB.

Which is better for prospective health care providers and which is better for underserved communities?

I don't have an answer, I'm interested in your perspectives on solving the maldistribution/shortage.

Interesting question. I think there are a lot of factors. Would a mid-level who loves his job and strives to provide the best care he can provide better patient care than an MD who regrets limiting himself to primary care and hates his life? I don't think there's any argument that an MD with a primary care residency has way more training and knowledge than a PA, and I've read a few studies showing that MD/DO providers have equivalent care to mid-levels while caring for more patients who are sicker, and while ordering fewer tests. I think having doctors will almost always be better for patients, but mid-levels are easier and faster to train, and most of the time they are "good enough."

My own opinion, however, is that more doctors is better for the communities.

Personally, if I weren't going through the military, I'd be okay with those limitations, especially if I was given some sort of scholarship to attend school and go into one of those specialties.
 
False. This exists in Spain and Canada.

Also, a single payer system is not socialized medicine. Its a midway compromise.

Socialized Medicine Examples:
-NHS (UK)
-VA (USA)

Mixed System (Single Payer):
-Medi-Cal/Medicare (kinda)
-Canadian Healthcare System
I didn't deny the existence; the second half of my sentence says why it doesn't work in practice.
 
The thing about being premed is you guys just don't realize how much med school sucks. Yes even with the promise of a 250k+ job after you get out, the process sucks so much you still wish you could quit at times. Med school isn't premed number 2 where you can do well and still have a social life, even the best students are constantly stressed out and sleep deprived to a much greater level than undergrad.
There must be only three types of people who want to go to med school: the self loathing, the naive, and the irrational ones who still want to pursue the field out of their "altruism" rather than go into something else because they couldn't "envision themselves doing anything outside of medicine!".
 
"Under every combination of scenarios modeled, the United States will face a shortage of physicians over the next decade, according to a physician workforce report released today by the AAMC (Association of American Medical Colleges). The projections show a shortage ranging between 61,700 and 94,700, with a significant shortage showing among many surgical specialties."

With socialized medicine looming around the corner no one's going to argue that US physicians will be seeing a decline in patients.

My question is what changes are going to be (or already have been) enacted to meet demand?

I really don't think the expression "Only pursue medicine if you can't see yourself doing anything else" is going to fly anymore. What rational person would choose to enter a much more physically, emotionally, academically, financially, etc, demanding field if easier alternatives exist? Medicine is a choice not a calling for most people.

So what are the options to meet demand?

- we increase the number of CNPs and PAs like we've been doing now but at the cost of quality of care since they're less trained.

- we open up more med schools——okay...easier said than done and you need more accompanying residencies to go with it.

- bring in foreign doctors——still need more residencies and it affects the "brain drain" issues in their countries; a win for us but a loss for them.

- ???


The earliest appointment I could get to see my PCP is in September! Insane!
I like winning
 
The Obama Administration couldn't even get a public option passed through an extremely Democratic House and Senate, so I really wouldn't expect anything close to what you're describing in the near future. And this is coming from someone who is most definitely not rooting for the Republicans.
They didn't really try very hard now did they? Dumped it right off the bat to try to generate cross-aisle support (ha!).
 
There's a lot of talk about a primary care shortage on this thread, but if you read the most recent report by the AAMC, some of the largest expected shortages are in surgery/surgical subspecialties. Indeed, the growth in residencies of surgical fields is slower than the growth in primary care residencies, and there is much less incentive to pack up and move to rural areas when you are already making twice as much as other docs.
 
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There's a lot of talk about a primary care shortage on this thread, but if you read the most recent report by the AAMC, some of the largest expected shortages are in surgery/surgical subspecialties. Indeed, the growth in residencies of surgical fields is slower than the growth in primary care residencies, and there is much less incentive to pack up and move to rural areas when you are already making twice as much as other docs.
The RRC does not expand residency positions without the prospect of a sufficient number and complexity of cases and supervision by trained and academically sound faculty. It is quite difficult to find all of these in the same location.
 
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Catching up on this post from the beginning so apologies.

The Obama Administration couldn't even get a public option passed through an extremely Democratic House and Senate, so I really wouldn't expect anything close to what you're describing in the near future. And this is coming from someone who is most definitely not rooting for the Republicans.
They couldn't get a public option through because TEd Kennedy died in office and they lost their majority. Circumstance was as much an issue as the politics. Plus, the politics aren't small. An aMendment called the Stupak-Pitts amendment barred federal dollars covering abortion except in cases of rape, incest, or harm to mother. This was the same type of legislation that is currently on the books in Colorado which led pro-choice groups to vote down their ballot measure in 2016 which would have created a tax based Medicare for All in the state. yay politics.

To take a different point of view, why would any practicing physician want more physicians? That just increases the competition from a business standpoint. I haven't started medical school so I don't benefit from this at the moment, but it's just economics 101 that if the supply of doctors increased, the income of all doctors would decrease. That isn't in the self-interest of current or future doctors.
To take a different position, if you're working in the NHS you are paid a set rate to be any specific specialty. So if you're a colorectal surgeon, you get the same salary per year regardless of how many fistulotomies you do. Some would hate that. They want pay for play. Crank out 500 of those a year and buy a summer home. Some would love it. Have more standard hours, make less, but have time to relax and enjoy the other aspects of life, like family.

Not that I know anything, but I've always wondered what would happen if the loan forgiveness logic were extended. What if the government (or some public-private partnership) guaranteed high salaries for doing primary care in these areas? If the government were guaranteeing competitive benefits, malpractice protection and a minimum $350k salary to practice primary care in rural Kentucky, wouldn't market forces drive primary care docs there?
The 5 most impoverished states actually have the 5 highest median salaries for PC docs. The problem, as someone else said, is that they have better $$ but live in areas that don't have great schools for their kids or the attractions/amenities to retain those physicians. That's why those states have been trying to expand nursing and midlevel programs.

Mid-levels providing primary care or medical schools training medical students who will be limited in the residency positions they can choose to family medicine, gen surg, psych or OB.
Even in OB/GYN the mose with physicians has been pushing to fellowships and specialization. It's almost too expensive to have an MD handle routine annuals for gynecologic patients. That's why you see so many fellowships in gynecologic oncology, high-risk pregnancy, etc.

This is where my own rant begins. First off, everyone needs to stop blurting out Econ 101 crap. Healthcare economics are way too difficult to water down to general supply/demand arguments, even dealing with just doctor supply. Healthcare is one of the least transparent markets in the US - a practice or hospital has a charge rate for a specific procedure, insurance has a negotiated rate for that procedure, and then we all have different co-pays, deductibles, and co-insurances. I had a cystectomy performed 2 weeks ago. Someone else with different insurance, done in the same hospital, with the same doc, will probably not be paying the same.

So the greater question really should be, is there a doctor shortage and what to do about it, but what is the roll of a doctor? Should the structure of primary care be the same? Should those be loaded with mid-levels? You're already seeing in Urgent Care groups a handful of MDs overseeing a team of NP/PAs spread over 3-5 clinics. They are there to see patients, but also to oversee and be used for referral in difficult cases. You only need one general to win a battle if they're provided with great field commanders. I for one, welcome this.
 
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Even in OB/GYN the mose with physicians has been pushing to fellowships and specialization. It's almost too expensive to have an MD handle routine annuals for gynecologic patients. That's why you see so many fellowships in gynecologic oncology, high-risk pregnancy, etc..

I presume that "mose" is a typo for "move". One can debate whether "routine annuals" for gyn patients are necessary at all. (the American College of Physicians says no; I'm sure that there are those with vested interests that would say yes.) Meanwhile, women in rural areas do have babies and they have complications and they need OBs (even the midwives need the supervision of an OB). Malpractice has made it almost impossible for family practitioners to deliver babies and so we do need general OB within the scope of 3 year medical schools designed to produce the docs needed to serve rural communities.

Just like Brave New World had technology producing babies that were well suited for specific roles in life, we perhaps need to select applicants to specific medical schools with the idea of filling various needs in society.
 
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