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Tuesday, December 10th 2013

Physician Shortage

Organized medicine continues to predict a large physician work force shortfall [PDF]. This will arguably be made worse by the expanded access (and presumably increased utilization that comes with such) granted by the Affordable Care Act.

But a recent New York Times op/ed is perhaps the visible challenge to the very public campaign organized medicine has led to make aware the public of the coming physician shortage. The piece is flat out titled, “No, There Won’t Be A Physician Shortage.”

While I am whole heartedly on board with questioning some of the reasoning models used to figure future physician demand, I’m not sure the authors of the New York Times piece don’t fully account for the real world workings fee for service medicine, in that their arguments seem to ignore the basic fact that physicians create their own demand in our current system.

That’s pretty blunt to say considering the authors are both physicians and notable health policy gurus. But here,

Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians. An average patient stay in the hospital is about two days or less following a stent but about seven days following a coronary bypass operation. Research on radiation treatments for breast cancer suggests that 15 treatments can be just as effective as the traditional 30 treatments. Likewise, one larger dose of radiation can be as good at relieving pain from bone metastases as five to 10 separate, smaller treatments. There’s every reason to expect the pace of these timesaving medical innovations to continue.

That’s a naive way of describing technological and procedural innovations’ impact on American health care. The way it works is when you do lap choles faster you just do more surgery. And in such a case the system continues to support the same number, or perhaps more, surgeons.

And, in terms of the workforce, who cares how long a person is in the hospital? That has no influence really on how many physicians we need.

We may indeed not need as many physicians as organized medicine thinks we do. Personally I think we may have some sort of shortage but the real problem is the ratio of primary care to specialists. If however we truly aren’t in the middle of a worsening shortage I’m not sure ‘technology is going to make us more efficient’ is the argument to make considering the way we currently finance healthcare in the United States.