Many countries have gone through periods of severe over-supply of physicians, Argentina, Israel, Germany are examples in recent decades. Yes, with over-supply, the job prospects and salaries drop precipitously.
Physicians of course like to have high pay to pay off debt, among other reasons, but plenty people are “allowed” to go into debt from graduate school without such prospects (law school is not that much cheaper). Whether it is good for society to artificially limit residency places is another matter …
Thanks for the informative points about physician supply. I am not close to this field at all.
So in the case where the physician supply is too high, I assume the patient costs come down. But have the reduced job prospects and lower salaries deterred the most capable aspiring doctors from pursuing a medical degree?
Also, a question aside from what is best for society… It seems students these days are more driven and accomplished now than a few decades ago. We see rising test scores, which may or may not indicate higher achievement, but qualitatively most high school students are doing more difficult and in-depth study than I remember from my day. Which further supports the hypothesis that there are highly capable students being shut out of the medical profession today.
A big part of the problem is that there are huge financial incentives for medical students to go into specialties, and not nearly enough into primary care.
No, actually the huge problem is the incentive system that originates from the bureaucracy that is our federal government. Do you know that because of their measures, Physician receive a significant amount of pay based on what patients perceive as quality care. If patients are happy, physicians get paid more.
How do you make a patient happy?.. You agree with them.
So for arguement sake, lets say a physician has the largest panel size, least admissions to the hospital, least number of patients readmitted to the hospital, least cost for tests and least costs for pharmacy, IT Makes absolute sense, to pay them the LEAST because they stand up to their patients, actually say no, have a lower satisfaction score and therefore have a lower multiplier.
HAHAHA. That would be really funny, if it was not absolutely a fact.
Actually, just so you know. When a doctor from a large organization sends in a referal for a colonoscopy to their GI department, it is given to the Doctor that has the open slot. If there are FPs who are employed physicians who work in the suite, they could actually end up doing your screening colonoscopy. Best to Ask if that concept bothers you.
^^^^Fortunately, I don’t need a referral. I go directly to the source for any care I need. My insurance is ungodly expensive (DH is self employed and I work part time with no benefits), but at least I get that privilege out of it. It does need to be an in-network physician, but I will be able to choose a specialist.
I have a crappy Medicare Advantage plan and I am referred to a gastroenterologist by my PCP when I need a colonoscopy. And if I don’t like the doctor, I can ask for a different one as long as they are in my insurer’s HMO pool, which is HUGE. (This is in NYC.)
Most rich countries have a higher number of physicians per 1,000 people than the US (Canada and Japan are roughly comparable; see https://www.who.int/gho/health_workforce/physicians_density/en/ ). Both physician pay ( https://journal.practicelink.com/vital-stats/physician-compensation-worldwide/ ) and cost of medical education (and resulting physician debt burden) is lower in those other countries. Of course, socialized medical insurance for part (like in the US with Medicare and Medicaid) or all (like in many other rich countries) of the population, as well as additional privately purchased coverage (often by other than the patient, such as by employers in the US) and the nature of regulations and markets affects what patients pay (which is often much less than the overall cost).
Most poor countries have fewer physicians per 1,000 people than the US. Cuba is an exception, with the highest number of physicians per 1,000 people in the world, due to historical reasons and government policies, and excellent health outcomes at low cost. But then most would not hold Cuba up as a desirable model for much else in how to organize governmental and economic aspects of society.
One issue is no one knows what the true cost to deliver a particular health care service is. The billed amount for a simple ER visit may be $3k, but the cost to the hospital to pay an ER doctor and nurse to see you for 15 minutes might be under $100.
As an aside, DH had a piece of a q-tip in his ear (yes he knows he shouldn’t use a q-tip, but he did— thats water under the bridge. He called our PCP’s office who suggested he go to an ENT. The ENT quickly and easily plucked it out (I guess with a tweezers type thing) and reminded DH not to use a qtip. The charge for this very brief visit- $552 (for a consult and “surgery”). Insurance allowed $281.95, which we paid (as it went to our deductible). So there are challenges all the way around in this broken system.
I would guess that if that information was available to the patients, he or she would have the least amount of patients. Who wants a doctor who doesn’t want to run tests, prescribe medication, or admit you to the hospital?
THIS IS EXACTLY WHATS WRONG…actually he has the most patients, yet the admission rate and readmission rates are the lowest. Those quality measures show that his patients do not end up sick,in the ER, and admitted to the hospital. Also, he’s doing it with less meds and less tests!
Given the dubious nature of some medical interventions (e.g. prescribing antibiotics for viral infections), it is not a given that a physician who prescribes more is the better one.
So who is this magical physician? Someone who only sees young, healthy patients? Someone who can wave a magic wand and cure all their patients without medications, tests, or hospitalizations? Perhaps a cardiologist who talks his patients into a massive lifestyle change, but you’d have to find people willing to do that. You can’t always pick your patients, and you can’t predict what they will do.
I haven’t read the thread. All I will say is that the system is SO HORRID that I had to find a professional patient advocate to coordinate my father’s care. My sister and I may pursue legal action against the hospital. When he told an aide at 3 am that he needed a doctor immediately, he was brushed off. By the time a doctor saw him, several hours later, it turned out his hemoglobin level had gone down to 5.7. He went into hemorrhagic shock. They rushed him into surgery and were able to clip off two bleeding ulcers. He is damn lucky he didn’t die. The only reason he didn’t was that my sister had insisted he go BACK into the hospital a couple of days earlier. She had to CRY to get them to readmit him.
That is just the worst example. It has been almost three months of hell.
So far, we’re liking the solution of having one of our lads becoming a doctor. Even at just over two years into med school, he’s been incredibly useful both to us for advice or translation and for seeing the “inside” of what goes on in his new world.
It’s important to remember doctors are humans with all of our species’ pros/cons. They have training, but also need to sometimes go with their “best guess” just like any other profession that requires problem solving and the unknown. Some are really talented at it. Some are merely trained for it. Some shouldn’t have made it into med school for one reason or another in spite of their test score/GPA. One could say the same about lawyers, engineers, plumbers, electricians, truck drivers, _______, etc.
I’ve grown to love having a good one in the family even if he’s still in training for the next few years.
We’re lucky enough to have computer/tech and plant/nutrition/green living experts too, both of whom are also whizzes with financial investing.
" Someone who only sees young, healthy patients? Someone who can wave a magic wand and cure all their patients without medications, tests, or hospitalizations?. You can’t always pick your patients, and you can’t predict what they will do."
Yes, this could be the solution, or instead maybe this doctor does not bring patients in for routine physicals that have never been shown to improve health and perhaps he doesn’t automatically set up a follow up visit to keep his schedule full and finally maybe he makes sure that you are seen on the same day, by him whenever you don’t feel well, or when your blood pressure is high, or when you when you actually need him.
Also, behavior changes often start when a physician is willing to point out your faults and ask for change, which very few physicians are willing to do now as it hurts the bottom line: see my earlier post.
@RW1 The type of doctor you are singing praises of is the only one I know who I actively despise. He almost killed my mom by telling her all of her issues were stress - for weeks/months. She ended up having to beg him for a Lyme test (grasping at straws). Before she even made it home from that test the hospital called telling her to have someone drive her right back to the ER immediately (or wait for an ambulance). Her hemoglobin was 6. 12 is normal. She had 4 units transfused as soon as they could - but hey - it was all stress in his eyes.
Her “stress” ended up being a stent needed for her heart, and then Stage IV esophageal cancer once a “real” doctor started investigating with tests and hospitalization. Had they caught things earlier she likely wouldn’t be passing away first of her siblings (5 others) and a good two decades before her parents did. But hey, think of how “good” his numbers are with tests and hospitalizations. (sigh)
She asked him if he would have had her blood tested if she hadn’t literally cried asking for the Lyme test. He mumbled something about not being sure. At the time he was sending her home even though she couldn’t walk more than a few feet without having to rest and his own nurse was telling him there was a problem.
Did I mention that some should never have been admitted to med school IMO? He’s first on my list. I have to bite my lip just to be sane in the same room he’s in when I’m with her/him. FWIW, he no longer questions anything she says but I still wish she would change doctors.