Thursday, May 10, 2007

Doctor Shortages - A Few Benefit At The Expense Of Many

The current doctor shortage is artificially created but very real in the hardships it imposes on patients and payers.

The only group that benefits from this scarcity are doctors themselves for obvious reasons. But now even some (though few) of the doctors talk of expanding the pipeline.

The case being made out is for Medicare and Medicaid to massively increase the allocations so as to expand the pool of residents. That will of course be money well spent, helping patients and saving money in the long term. But even this may not be necessary.

Most hospitals value their residents. Anyone who has been to a hospital (or even watched shows like Grey's Anatomy or ER) can see how much of the work and care is handled by medical residents. They are after all skilled (particularly past the first year of residency) and cheap labor drawing $40-$50K a year for working 80 hour weeks. Some of those hours may go into classroom-like training or learning by watching, but most of them directly and considerably benefit the hospital.

So why not allow hospitals who want extra residents (outside of caps imposed by the ACGME or RRCs) without subsidies from Medicare to simply take them on? Many experienced foreign doctors also can be brought in this way, who can more than earn their keep as residents from day one. Then there are US medical students who are currently excluded from residency (or residency in their preferred specialization) because of the caps on such residencies. They may be required to pay their way or forgo a part or all of their stipends to the extent that hospitals consider them worth taking in without receiving subsidies. Or they may be required to execute a bond that commits them to work for a certain period at that hospital after graduating, or else to refund their cost of training. Whatever the arrangement I predict there will be no dearth of deserving takers for such offers.

Ignoring any special interests that benefit from the shortage and launching a concerted effort to vastly expand the physician supply should be a top priority for the government.


Anonymous said...

Drugs in the US are high for several reasons:
1. Someone has to pay for the research.
2. We research too many trivial diseases that not many people suffer from, eg Lou Gehrig's disease has only 30k sufferers, while cancer and heart have millions.
3. Too many headline procedures like separating conjoined twins, botox, lifestyle drugs like Viagra.
4. More drugs should be made available over-the-counter instead of through the pharmacy.
5. Are the imported drugs really safe even though they may be cheaper? Take the case of the Chinese cough medicines that were contaminated reported in the NY Times on May 6, 2007. Even the Canadian govt. cannot certify the quality on drugs bought over the internet.

Sandip Madan said...

This above comment apparently relates to the earlier post of May 9 on drug prices. So I'll copy it there along with my response.

Anonymous said...

Yes, it is ironic that we debate whether we should allow more illegals in to do the dishwashing and gardening, while doctors have minimized the number of medical practioners that are allowed to enter the country. If more doctors were allowed to immigrate, the cost of medical insurance and hospital charges would plummet.
We should lower the immigration quotas on the lower skilled workers so there is less poverty, and increase it on the doctors and lawyers(God forbid) so those wages come down.

Originally posted on May 10, 2007 11:14 PM

Sandip Madan said...

Thanks, "anonymous." Increasing the supply of doctors is indeed vital, and an effective long term measure is to remove this system of residency caps as well as removing other barriers to entry into the profession.

For quicker relief as you say the only effective answer is expanded immigration, coupled with changing the licensing requirements for qualified foreign doctors so that they don't have to start afresh with a residency.

I'm not so sure I'd like to see lawyers imported here. Unlike for doctors there is no artificial cap on the pipeline for lawyers, and we already have too many. :-) The reason for the high litigation costs has more to do with the frictions, inefficiencies and adverse incentives within the system, rather than a dearth of lawyers.

Anonymous said...

youre an idiot.