Several days ago I made the point that no matter what the government is now doing in trying to contain healthcare costs, the effort is fundamentally flawed because there is nothing in the current legislation that will increase the number of MDs, Nurses, Technicians and treatment facilities, and therefore as the number of people who are using the healthcare system increases, there must be a reduction in the amount of healthcare available to any individual.
This leads to a simple question: what might government do to increase the number of doctors, nurses, technicians and facilities across the nation? Before I answer that, let’s look at some simple numbers.
US Population: 305 million
US Population in 2025 (est.): 350 million
Number of people who receive regular healthcare: 250 million
Number of Doctors: *818,000
Ratio of Doctors per patient
(for a population of 250 million): *1/306
Ratio (for the entire population): 1/372
Ratio in 2025: 1/427
Number of Nurses: *2,468,000
Ratio: *1/101
Ratio (for the entire population): 1/123
Ratio in 2025: 1/141
* Numbers based on the Statistical Abstract of the US as of Dec 31, 2007
Of course, this doesn’t tell the whole story; for example, many doctors are specialists, so the availability of general practitioners to provide initial care is perhaps a more important figure and that number - a subset of the 818,000 – has been dropping slowly but steadily for quite some time. Higher costs for malpractice insurance and the cost of maintaining an office for a private practice, as well as strong positive public perceptions concerning various specialties has lead more MDs to move away from general practice resulting in a sustained negative trend in general practice. Any solution must address both increases in total numbers and increases in primary care or general practice medicine.
It should be noted that for several decades the American Medical Association argued that there was a glut of MDs in the US and lobbied Congress (it went into effect in 1997) to only fund 80,000 medical Residents per year (through Medicare), with the Veterans Administration funding another 20,000 per year, for a total cost to the taxpayer of roughly $11 billion per year. Several thousand more are funded by states or private organizations.
As of 2007 the 120 US medical schools were conferring 15,730 MDs per year. That number has stayed remarkably consistent for nearly 30 years, with 14,900 MDs conferred in 1980 by 112 medical schools. (As a point of comparison, US law schools produced 43,500 lawyers in 2007.) Roughly 25,000 MDs were entering practice in the US each year, the difference made up of doctors entering the US with degrees from overseas.
Further, the answer must have two parts: what to do in the short term, and what to do in the long term.
In the short term, there are only way two ways to increase the number of doctors and nurses and technicians, and both must be used. The first is to provide encouragement for those doctors and nurses who are thinking of retiring to remain active and in medicine. The most reasonable path to do so is to offer a break on income taxes for those who choose to remain in practice rather than retire.
The second means to increase the number of doctors in the near term is to actively recruit overseas. Hospitals should be encouraged to do so and might be given tax credits to provide for recruiting bonuses. Medicare and the VA might also be provided funds for recruiting in the form of bonuses for qualified MDs and nurses.
Both these programs would need to be sustained for at least 15 years as the second half of the program was developed. That second half is simply put: we need to produce more MDs and Nurses. To be clear, by 2025 we as a nation will need well more than 1 million doctors and 3.5 million nurses. If we are going to be able to provide our own doctors and nurses (assuming an average professional life of 35 years), US medical and nursing schools will need to produce 30,000 MDs and 100,000 Nurses each year. This will require doubling the output of both medical and nursing schools in the next 15 years.
Current medical and nursing schools need to be expanded to their maximum capacity, new schools need to be opened. Doing so without suffering a drop in quality will require a great deal of discipline, but it is possible and there is no other option. Attracting intelligent students into medicine instead of other fields will be a challenge. It will require a change in social dynamics that returns medicine to the top of the cultural ladder for preferred jobs, a matter both of income and, more importantly, social status. It will also require curtailing the negative impact of litigation both on the material cost of medicine (particularly malpractice insurance) and the social cost, the reticence of some to go into medicine, and for those in medicine, a hesitancy to enter into certain types of medicine. This problem and can be successfully addressed, but there is nothing that the federal government is now doing that will do so.
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