Shannon Brownlee, in the December 2007 issue of The Atlantic Monthly (subscription required for full text) writes about what she calls "the health care crisis no candidate is addressing." She posits that we may have too many doctors in this country. Excerpts:
"Some experts would even go so far as to suggest we need fewer doctors, not more. Elliott Fisher, a physician and researcher at the Center for Evaluative Clinical Sciences at Dartmouth Medical School, quipped at a recent gathering at the Institute of Medicine, "If we sent 30 percent of the doctors in this country to Africa, we might raise the level of health on both continents." ...Posted by schwitz at December 11, 2007 08:29 AM | TrackBackAs for the rising number of physicians being trained, the remedy is simple: Turn the spigot back off, or at least close it part way. The groups now calling for more physicians should come up with better evidence that all those new doctors are not going to simply drive up costs."
I personally think she's brilliant. After all, if we had fewer pilots, we'd probably spend less on air travel!
Ha ha ha ha.
I can't believe someone published an entire article in an otherwise well edited magazine based on a circular argument.
Posted by: Zagreus Ammon at December 11, 2007 09:12 AMAh, we have all been following the arguments in Minnesota about not enough doctors? The U of M, despite poo-pooing the idea when espoused by St. Thomas, all of a sudden increased their (our) enrollment by about 20.
What do you think is going on here? Do we have a shortage or not?
Based solely on the pressure on physicians to push patients through our local HMOs I'd be inclined to say there is a shortage. But I'd be interested in hearing the take of the blog author on this?
Ciao,
Bonzo
Posted by: Bill Gleason at December 11, 2007 08:04 PMI don't think the "pressure on physicians to push patients through our local HMOs" is a reflection of any physician shortage. It's a business decision, a systems engineering decision, not unlike the systems analyses that dictate how many pieces-per-hour should be produced on an assembly line. It's not a question of how many workers there are on the line. It's a question of how much work you can get out of each worker - no matter their number.
The brief UMN-St.Thomas spat over the latter's proposal to start a new medical school - to me - was primarily about competition and reputation and posturing. I didn't hear a convincing argument - on either side - about need.
I do think that some physician factors don't get enough attention in health care reform discussions. How much they make. How many conflicts of interest exist in research, in patient care, in medical education. How variations in practice patterns are almost inexplicable. So in that regard, I would broaden Brownlee's opening statement about factors in the nation's health care crisis that no candidate is addressing.
Posted by: The Publisher at December 11, 2007 08:55 PMZagreus -- the problem with medicine is the economic pressures don't work the same as they do in other industries. Read my piece and then see what you think.
Bill -- The Publisher is right, pressure on physicians is not always a good measure of true demand, which in the case of health care should be the medical needs of patients.
As it happens, practice variation is at the core of my argument for why we don't need more doctors. It's sufficiently complex that I'm not going to try to reiterate it here. But the reason I say it's the most important health care crisis no candidate is addressing is the push to train more doctors is already in motion. THe problem of practice variation is scarcely on anybody's radar screen.
Posted by: Shannon Brownlee at December 12, 2007 12:00 PM