The Doctor Shortage in the US: Is It a Real Thing?
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- čas přidán 26. 12. 2016
- Many people have to wait too long to see a doctor. And it could get worse. If, as many people believe, we have a shortage of doctors in the United States, then it follows that we can fix this only by training and hiring more physicians.
As with almost everything in our health care system, though, it's complicated. Some people think there's no shortage at all - just a poor distribution of the doctors we have.
That's the topic of this week's Healthcare Triage.
This episode was adapted from a column Aaron wrote for the Upshot. Links to sources and further reading can be found there: www.nytimes.com/2016/11/08/ups...
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
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It sounds a lot to me like the financial issue isn't that we don't pay physicians enough, but that the cost to become a physician in the first place is far too high. Personally, I think that the cost of education in general in all fields is too high, but there is so much pushback against government assistance (beyond just loans, obviously) that it doesn't seem like we'll ever solve this problem. Healthcare is just one of the few where the issue is most obvious.
Govt makes universities more expensive since they let universities spend more. Universities are spending more money per student than ever.
I'm not advocating that the government give the universities more funding. I'm advocating that they give prospective students money so that they can attend them. And not just universities, but even and perhaps especially community colleges, trade schools, etc.
stellarfirefly I think what Diana was alluding to is the catch 22 we're in right now. As the government (state and federal) provide scholarships and assistance to students it's up the universities, community colleges and trade schools to make themselves more enticing to their customer, the student. So what we have is a ton of unnecessary amenities in these schools that drive the cost of tuition up without increasing the quality of education. If the government provides more money what will happen? Will more students complete school with less debt or will schools continue to add amenities to make themselves more competitive?
If that's where the problem lies, then the only solution I can see is to stop running higher educational institutions like businesses altogether. Let them emulate the public school system, which still means increased government spending in education but removes competition between schools.
I used to wonder if the true cost of medical education really is just so high that we must charge students so much. But comparing the costs of different programs shows a laughable spread. In my region alone, similar programs can range between $4500 to $18,000 (and upward of $40,000, if you expand the regional search all the way to the nearest major city) per student, as an example (vocational nursing).
stellarfirefly. Giving perspective students money to go to college is no different than giving schools money. The only difference is that students pick where it is spent. The solution is giving students less money and more carefully. People should be able to default on their student loans and government support save for merit based grants should be withdrawn. If people could default on their student loans, banks would be forced to loan out their money more carefully or risk loosing their investments. Reducing government support significantly lowers the amount of money people are willing to pay for college. These changes motivate banks and government institutions to only give money to people rich enough to pay it back, smart enough to pass, and hard working enough to make good use out of the educations their receiving.
In the short term alot of people simply won't have access to higher education since colleges will be too expensive for them to afford without the wide availability of student loans. In the long term colleges will have to cut costs to keep enrollment up. Slowly but surely college will become more affordable, and their degrees more valuable because less people have them.
Who want to be a doctor when you get out of school with hundreds of thousands of dollars in debt. We would have more doctors if higher education were free.
I want to be a doctor, I only have an MD! :D
J.J. NOX they can easily pay that debt... the starting salary for them is 6 figures for fuck's sake.
did you watch the video?
Abraham H nope it's not
I mean, there are definitely some people who go into medical professions for the money, but most people I know who choose that path choose it because it really is what they want to do. They like medical work. They like helping people. They want to make sick people better. They do make a decent living once they finish off that residency, so many of them feel the debt is ultimately worth it. Still though, I'm sure many medical students would be all too pleased to be able to graduate with less debt.
America: We have a shortage of doctors
Medical school: Oh, you want to be a doctor? That'll be $300k
If you want a lot of doctors, then be prepared to lower the quality of these doctors. Believe the rich will continue to have good doctors, and you will die in the hands of non-professionals.
Uh very few public med schools cost 300k... most private schools like UChicago and Hopkins cost 395k-400k.
those countries have free college allowing more doctors and nurses.
also "oh you want to be a doctor?"
you don't have a 4.0 gpa +shadowing+volunteering+rewards....+recommendations+hobbies+research
Paul Architector nah. More like the rich will get their top shelf care, and the poor won’t be needing to die because they’re unable to get medical treatment.
I own a federally designated rural health clinic. I'm a board certified family doctor. At the end of this week I am closing my business. Revenue couldn't keep up with expenses with the biggest factor being the difficulty recruiting physicians. I, the doctor who works for me, and essentially all of my employees have been hired by the local Federally Qualified Health Center so services will continue in the community but we will not be in a better position to fill the need.
Did an FQHC move in even though you already had a RHC in your area?
Yes. They already have a facility two buildings up the street. They have about 15 other facilities around the county and two adjacent counties. Their per visit rate is more than twice mine.
Auuughhh! I hate to hear that. They should have to account for presence of RHCs before moving a new FQHC site into your town if you had a sliding fee schedule.
Im a med student here in the US, I was trying to decide if Primary Care was for me. I decided it wasn't. All the FM physicians I worked with in med school were burned out. Most had moved from private practice to work for organizations like Kaiser Permanente.
I know there are financial incentives to do FM rurally, but I dont want to move rurally and my debt is far too high
Back in the day, a newly graduated doctor could start a rural clinic and be reimbursed by insurance or paid out of pocket and make a decent living. With the cost of medical school rising, health insurance paying less and limiting services and physician choices being made outside of the office the choices for a general practice doctor seem to be limited to either working for a large hospital or private group. There is no easy fix to this problem as many communities are losing their small town doctor's offices and patients are being forced to travel farther and go to larger clinics owned by hospitals. Using physician's assistants and nurse practitioners is a solution but does not impact the control that insurance companies have in terms of reimbursement. The rising cost of malpractice insurance is also a huge determination for many solo practitioners. Being under the umbrella of a large corporation protects physicians from having to pay such high insurance costs. I am sorry that your clinic has to shut down, it seems that the current state of medicine is tied more tied to insurance and governmental issues and less on serving patients. Doctors should be able to practice in different locations, economic markets and areas without having to go broke to do so.
I agree with you, and thank you for the research. In my opinion, I feel like the US is making it overly difficult to graduate from medical school, and also the tuition is way too high. That's the reason why I want to pursue other field, such as pharmacist, which has a bit lower tuition and still make a fair amount of pay compared to medical school people.
I agree. I have an MD and left the field because residency is BS to get into. It sucks since my debt is the same as other doctors and I am making and will continue to make significantly less money than a doctor would, but that's a mistake I have to own for myself.
The tuition isn't necessarily better as a pharmacist, but you get to full salary faster technically. Just for pharmacy school my husband has over 200k in loans.
kennyc002 I left med school after passing my boards too... it's a long road and people don't quite understand how different it is financially and otherwise when compared to other professions. Yes, we can/do get to the top 1% but only after putting ourselves in debt over the course of over a decade. By the time we're in the 1% (usually in 40s-50s if we're lucky) we're saving that money for our kids, or some form of retirement unless we die first. (This also happens a lot)
Drew Tepper ah good to see a fellow MD who also left. Lol
Current pharmacy student here. I would not say it's cheaper. I will graduate with over $160,000 in loans. However, you can get a six figure salary straight out of pharmacy school, and even if you do choose to do a pharmacy residency, it lasts for two years rather than the 4+ years a medical residency takes. So it will be just as expensive, but you'll have a respectable salary faster.
Maybe if doctors spend less time dealing with insurance companies they'll have more time to help more people
Yes Uk, Canada, Germany, Sweden and Denmark are experiencing the same thing yet they have free universities and free healthcare
This is why we should reduce privats plans.
David Dorante
Probably because they pay their providers a 3rd as much and work them just as hard as they do in the US.
Doctors do not want to deal with insurance companies as part of their jobs. They speak with them to get needed procedures and medications approved for patients as insurance denies these things
I was a science major and 90% of the incoming freshman wanted to become doctors. By senior year only about 2% still wanted to be a doctor. Most people (me included) decided it wasn't worth it by the time we graduated. Not only was it insanely competitive (even for 4.0 students) but it also required another 5-8 years of training and hundreds of dollars of student loans. To make matters worse, the salary isn't often worth it for the price of becoming one. Therefore most of the students went on to different careers that paid well but did not require you to throw away your life or your chance of retiring at 60. Right now my peers and I are becoming nurses, PA's, genetic counselors, physician assistants, world health specialists, etc. From my perspective the individuals who are going into medical school are 1) from cultures that see being a doctor as the only option to be successful 2) students from wealthy families who didn't have any undergraduate loans and had the funds to travel on humanitarian missions in the summer
Sounds sad
I don't think most decided it wasn't worth it, but rather most doubted in their ability to get accepted into a US medical school.
There are about 20k slots for medical students and about 50k applicants every year. Make more medical schools and residency slots and you'll get more doctors.
Making medical school cheaper might help.
Actually, it won't really. Medical schools aren't opening up more spots so they look statistically better on the match (for residencies) and residencies don't open up more spots because there's a lack of funding and training residents is expensive. I think the statistic is ~40% of medical school applicants get in each year and most of that 60% are highly qualified individuals at that. I'm not disagreeing that the cost of medical school is ridiculous (I'm looking to be ~350k in debt in 4 years), but it's definitely not the biggest bottleneck.
@Hugh Huynh Interesting, but do you really think medical schools don't open more spots so that "look statistically better on the [residency] match"? To me it would seem irresponsible to open up more spots if they know those students won't go on to match, so I wouldn't think it's just a matter of saving face.
Sorry if I made it seem like it was the only reason, but I'm sure it's a contributing factor in addition to what you put. The whole healthcare industry is all sorts of messed up and I'm sure it's difficult to pinpoint a single major contributor.
spectacles testicles wallet and watch, it might comfort you to know you can earn your medical degree at many schools in the US without stepping foot on campus more than once or twice a week for a few hours. Our didactic classes are streamed (recorded & uploaded to a school website) and rotation years are spent mostly in clinics.
This presents a (for me) compelling argument why medical school should be free. The tl;dr is, the total cost of medical education is only a rounding error in the grand scheme of things-a fraction of one percent of the annual cost of US heaalthcare.
www.nytimes.com/2011/05/29/opinion/29bach.html
The biggest issue to this "doctor shortage" in my opinion is the medical schools. Medical schools want exclusivity and a favorable staff to student ratio.
With this medical schools intentionally keep their class sizes small. For instance one of the major medical schools in my state released their statistics a couple of years ago. They had over 6000 applications sent in, they interviewed around 1500 applicants and admitted each year only 100 students ( which they have not increased in years). That is ridiculous at a less than 7% admittance rate of those that interviewed (typically as long as you meant the minimum qualifications and the application was sent in before the deadline you received an interview). This isn't even a top 20 medical school by any of the rankings. What do they lose by doubling that to 200 students admitted per year?
We have a horrendous shortage of specialists on the smaller Hawaiian Islands. The costs of flying patients to Honolulu is rediculous. It's hard for new docs from the Mainland to live so far from their families. We are trying telehealth
Im a Canadian training to be a doctor in the US (attending a US medical school). I agreed with everything he said except implying midlevels should get more power.
I've worked with many midlevels. PAs (physician assistants) and NPs (Nurse Practitioners). They absolutely play SOME role in primary care, but giving them more power is dangerous to patients. They undergo substantially less training than physicians and it shows. I'm about to graduate medical school and I haven't even started residency yet (which will be another 4+ years of training) and I continually catch mistakes from PAs and NPs. You cannot cram medicine into 2 years (PA education). There is simply way too much physiology, pharmacology, and pathology to learn. NPs at least require a BSN then a masters degree. Oh did I mention NP and PA programs are available online. People in charge of your lives can get education online! That's not sketchy.
Midlevels are great for dealing with non-complicated patients. Sore throats. Coughs. Basic diabetic stuff. As soon as the patient gets complicated, they are more of a risk to patients. This shouldn't be an issue. Simply refer that patient to a physician. However, ego gets in the way. Too many midlevels think they can manage these patients when they can't. Giving prescribing rights to providers who learn the very basics of pharmacology is dangerous.
These people want to be doctors, but don't want to put in the time for the appropriate training. They have the potential to significantly decrease spending/resources, the issue becomes regulating their scope of practice, which should be limited given limited training
I agree that the complicated cases should be handled by those competent to handle them.
But competence is hard to measure.
Wouldn't you say there are plenty of incompetent doctors as well ?
The types that have elephant memories so they pass every test but have no real understanding of what they learned ?
An educational institution *should* be a control mechanism of competence.
But lets be honest if any control mechanism of competence works then it does not matter where you got your education from. So in essence i would trust my life to someone who got his education online if there is proof of competence.
You say these people want to be doctors ? no it's more likely these people want to help other people and get payed doing so and therefor chose a career that was possible for them according to their life situation.
I believe you are projecting your superiority bias and are not judging the situation objectively.
"These people want to be doctors, but don't want to put in the time for the appropriate training." ( ergo unlike me )
except for that i completely agree with you :).
cjrosse wow I didnt know about classes being online..that's scary
Agree👍
No, Uk, Canada, Germany, Sweden and Denmark are experiencing the same thing yet they have free universities
let's be specific here, there are online courses to go from the RN level up to the BSN level. To get an RN (at least in my state) you have to first take the CNA course, including the clinical hours, then go through a 4-year program, including clinicals and through the gauntlet of old nurses (which can tear you up and spit you out). Then you might be able to go through a 2-year program to get a BSN, PA or even NP, all the while more than likely you're getting more patient contact than a Doctor ever would.
As you go through your training, you should listen to your nurses, they are the ones that are with the patents day in and day out, they can tell you when someone goes off of baseline. Don't try to build walls saying that they arn't as good or as needed as you are, you can't be everywhere, noone can.
Med School has too high a bar of entry, to high a cost of education, and the length of requirement for school is too long. The fact that Physicians Assistants and Nurse Practitioners are doing much of what general practitioners do for only 2 years of graduate school and half the cost of medical school shows that Med school is too long and too expensive. Secondary settings need specialized doctors with extra schooling, but that education shouldn't cost $500,000 because it's created situations where those in need have to wait a month and the costs are expensive.
Government: Please make the price of medical schools cheaper! Fewer people want to go into primary care because the salary is too low in order to offset the cost of medical school. Why do I have to take out a minimum (b/c I'm a hs senior and the price of medical school will no doubt go higher when I enter) of $228,000.00 in order to become a doctor?
MultiEquations you can easily pay it off
no you cant. Not in decades, actually. at 50k a year that would be 5 years at least, not counting living costs, closer to 25k a year and 300k after interest, youre looking at ten years+
Abraham H it takes roughly 25 years to 'break even' from debt after residency, which means you aren't really making money till you're around 50 and you have to hope you don't die by then or have any medical expenses yourself. It's very high risk and low reward. People outside of medicine don't quite understand unfortunately.
In other countries, people go straight from high school to the physician track based on their college entrance exam score, whereas in the US one has to finish a 4 year degree just to be eligible to apply to medical school. That is a barrier to entry that just adds to the expense of medical school. Also, general education courses in college could be self-study in order to reduce the cost of higher learning. With the exception of labs, hands-on, in-class learning is not necessary for many courses.
Education is a business. There are university presidents in the U.S. that earn in excess of one million dollars per year and some that earn multiples of that.
The best way to reduce the cost of education is to get away from the tuition model and go toward a self-study and exam model, as is the case with professional licensing exams.
Just to clarify, there are BS/MD programs in the US, but they are few in number. I personally think that having to get a bachelor's degree before applying to medical school is beneficial for the applicant. It's hard to be sure that you want to be a physician when you're 17-18 years old and those college years can help some people realize that they really don't want to be a doctor and others solidify their aspirations to become one.
8 years of college when most millenials can't even afford rent.
Yup, pretty much...
A potential solution is to allow for MDs without a residency have a less painful pathway to become a mid-level practitioner such as a PA. Annually there are over 30 thousand MD applicants in the NRMP match that do not match each year. Even if you assume only half of these people are qualified, that still gives us a substantial number of people who can go into that pathway. Currently there is no real pathway for that. You have to go through a PA program (which is additional time and money investments) to be able to qualify to be a mid-level practitioner. That's a ridiculous proposition to make for anybody who's passed at minimum the USMLE step 2.
I think that assistant physicians are the way to go after the physician. It's clear that a medical graduate is far superior in clinical and medical knowledge than a P.A that does a 2 year masters. You guys should take a look at the new act that Missouri passed. I'm on board all the way!!
I work as a software engineer for a big-name tech company. I am paid well. I volunteer in EMS and enjoy medicine.
I could go to medical school and help alleviate the doctor shortage. The last time I did the math, it would take me at least 12 years to break even, assuming I got a full scholarship. It would take even longer with tuition debt.
I still look for opportunities to make this work. But it seems that the system is structured against me. There's no way to go to medical school part time, there's no way to be paid my current salary to go to medical school full time, and MD/PhD programs are crazy-competitive to get into (despite my interest in research). It seems that the medical cartel doesn't want to facilitate competition.
Exactly, who wants to volunteer for that?
You forgot that if you fail medical school you could end up with a 100-200 grand in student loans and nothing to show for it. Medical School has its risks.
I did a back-of-the-envelope calculation of plumber vs. pediatrician a few years ago. Ignoring time spent at work, the pediatrician came out ahead in their mid-fifties. That assumed $250k med school debt. Now, plumber, especially master plumber is a pretty good job, but you didn't need to be in the top 1% of high school graduates to get there.
Essentially, it is no longer financially beneficial to become a primary care doctor, when debt and lifetime earnings are evaluated. Real income has dropped by 1/3 since the mid-'70's. Nobody should do it, unless that it their passion. And don't worry, that will get beaten out of you.
Master plumbers sit at 80k a year while the average pediatrician sits at 150k a year. Even at 250k It doesn't take long for a doctor to outearn a master plumber. Paying off your debt immediately is a bad idea for a doctor when they can save up in 2 years and ave 80k in cash to purchase 500k dollar house.
Doctor in 30 years makes 4.5 million before taxes. It would take a plumber working to almost 90 to be able to make as much as a doctor in their 60's. For comparable years 250k is nothing.
You have neglected to factor in all of the variables. And master plumbers are in the 100k range. You have neglected the interest on the debt, and the loss of earnings the pediatrician suffers while the plumber is generating income. The pediatrician is training until they are 30, then starts to earn, assuming they jumped onto to medical school treadmill right out of high school. The plumber has been earning all of that time.
Remember, you have to factor the accumulating interest on borrowing, and the interest on the interest. You also cannot compare "before tax." Interest on debt is not tax deductible, and taxes in the 150k bracket are in the 50%-65% range, all up. The pediatrician pays both ends of the FICA, remember. And nobody pays for their retirement fund.
Pediatricians just out of training have around $50k earnings after taxes and interest payments. To have 80k in two years, they would have to live on $10,000/yr. More likely, they would struggle to save $5k for 10 years.
You're amazing, I hope you never stop making videos and only success comes upon you. Sharing your channel for hopefully many more to follow.
Keep educating.
As long as the AMA controls doctor training, there will be a shortage because it is in the doctor's best interest to limit the competition.
The AMA doesn't control doctor training and the number of physicians per capita has gone up over the years, including because we have a huge number of International Medical Graduates who come practice in the US.
Phil Heaton as I said above it's not the AMA, Medicare needs to pay more for more residency slots and they aren't going to. The AMA wants more residency slots. There isn't a shortage of patients, it's not like other business models.
steveh46 I could be wrong. I remember complaints about the system from when I was younger; the AMA both needed to approve of the training standards being taught, they had to approve the maximum number of students allowed in each year's class.
Why can't hospitals pay for residency the way that all businesses pay to train their entry level workers?
Because no hospital would ever take on the expense and very few drs would be trained and medical care costs would explode. for the 100,000 residency slots in the US it costs nearly 9.5 Billion dollars a year for teaching hospitals.
www.acgme.org/Portals/0/PDFs/2015%20AEC/Presentations/ses031.pdf
This is a pretty good presentation of costs, cost control measures and impact on doctor loss.
The reason is demographics: babyboomer populations were HUGE compared to the silent generation. Millenials barely beat babyboomers in population size. Now they the babyboomers are aging rapidly and used up lots of resources, didn't keep tabs on college tuition prices and basically passed on economical problems onto their children. Now they are in serious trouble, this doctor shortage will be a MAJOR problem soon.
I agree that Advanced Practice Providers (aka mid-levels) need to be used more. I disagree with states allowing Nurse Practitioners no oversight and independent practice.
Mid-levels are anything but advanced. I've worked with many. They can definitely handle basic primary care issues but as soon as a patient is slightly complicated, they are a risk to the patients safety. Sorry, but they don't go into enough detail in pharmacology, physiology, and pathology.
Giving NPs independent practice is a huge risk to patients, despite how badly they want to play doctor.
this video makes solving the problem seem too easy and oversimplifying the issues. First of all ARNP midlevel providers are not trained and extensively in primary care. You are absolutely wrong, generalists are the first to see patient's therefore in some ways the hardest. They need to be able to sort between simple and complicated cases and to treat properly. ARNP/midlevels are only trained to treat with simple cases and algorithms. In a increasingly sick society we will need to depend more on properly trained doctor as our patients are actually becoming more complex and living longer. Your statement stating midlevels are just as equipped to provide primary care is false and a very dangerous statement based on ignorance. You clearly dont practice medicine and have sat in an office with a type 2 diabetic morbidly obese patient with so many medical problems. Please research better before you preach inaccuracies. You are a danger to society.
I can't be the only one who misread this as Doctor Strange in the US
We may need more doctors graduating med school, but what we really need is more residencies for them when they do. ~30k doctors don't get residencies and basically can't practice.
Even in Austria media talk about a doctor shortage (in the future, but still). That video put this discussion into perspective, thanks! :)
Doesn't look that way
nces.ed.gov/fastfacts/display.asp?id=98
You realize that I'm not a US citizen?
Well, yes. But college is still payed for by the taxpayer, it's kind of like a reverse public pension scheme
I originally got accepted to med school but I have a six figure salary w/o an MD and have five kids; it just didn't seem reasonable to me to go to school for 4 more years plus a residency while risking the most important years of my children. I want to be a physician more than any career but it's a really hard decision w/ my kiddos-the youngest not even 2 years old yet.
Make it stupidly hard to meet the entry requirements for uni instead of letting the course kick out those not making the cut and its very expensive to train and takes a long time
In the northern part of michigan there is a shortage of doctors because the DRS do not want to work in the upper part of the state why because thier wives dont like that they cant shop at bloomingdales because there are none in north part in mich you have to wait close to 6months to a year to see a specialist like an orthopedic or cancer surgeons which causes a poor continuity of care and patient is sicker mich has nine medical schools none come up to the city's above lansing mi this could be helped if the graduating drs Bill's for school are written off and they are given incentive to work in northern mi
I live in Boston and we have some of the best hospitals in the country (and very many). There are thousands of doctors within easy driving distance of me, but between not very good insurance and a number of personal factors that restrict the pool of availability, I can't find a primary care doctor. And the only specialist in the area who knows about one of my conditions and takes my insurance has an eight month waiting list for an appointment. For certain people, there is a shortage of available and competent practitioners, both generalists and specialists, and I agree from experience that the issue seems compounded by insurance issues.
In my opinion we have a doctor shortage because people do not want to go to school for the long time that being a doctor requires. I am sure many people would love to be doctors but motivation is not there for them, they'd rather take the easy way out and become a nurse or physicians assistant. Also another reason might be because college is becoming more and more unaffordable. If students do not have a local college that they can go to the price is outstanding and many students do not want to go into that much debt for a degree, they will be paying student loans off for a while and that is something most people do not want to do. It is hard enough trying to support yourself but imagine having $100,000+ in debt you have to pay off. I do not necessarily think we have a general doctor shortage but I do think we have a specialist shortage for the amount of people who need to see them in America. When you go to a specialist you wait forever because they have overloaded schedules with too many patients that they realistically cannot see in one day because they are the only specialist in the area.
Why are there more doctors in Nordic countries? Because they can enter med school from high school and do not need to get a Bachelor's Degree before that, and because med school is for free.
the catch is that you have to study it in the respective native language
not sure why that's a catch-- that only makes sense? i don't think cosme was suggesting we teach more doctors for free, but exclusively in a foreign language haha.
No Uk, Canada, Germany, Sweden and Denmark are experiencing the same thing yet they have free universities and free healthcare
Sources: newsinfo.inquirer.net/1027682/swedens-healthcare-system-bogged-down-by-shortage-of-doctors-nurses
www.dw.com/en/german-doctor-shortage-begins-bleeding-into-the-west/a-2812698
www.independent.co.uk/news/uk/home-news/gp-shortage-nhs-leave-doctors-pay-hours-a8376266.html
www.fraserinstitute.org/article/canadas-doctor-shortage-will-only-worsen-in-the-coming-decade
Norway also has a shortage of doctors.
Just FYI, here in Austria there is also talk of a shortage of doctors. Here it's more a problem of rural vs city distribution of physicians.
Thank you for actual an policy focused and nonpartisan videos
I think you would make an awesome professional reference guest on the show "Adam Ruins Everything" ☺
I find it foolish to compare many things to european countries. Their ENTIRE country is smaller than many of our individual states, yet they are very dense making all sorts of things much easier to manage. Distance to doctors doesn't compare as it takes only a few hours to drive across entire countries in Europe and major cities are much closer to each other. Major cities in the US are separated by as much as thousands of miles.
I wonder why people that live in rural areas and are getting worse medical care because of a doctor shortage in their area don't move closer to a city or suburb where there are more doctors. Even if housing is more expensive in those areas, they can just live in a smaller place that they can afford. The more spread out people are, the more inefficiencies there are in an economy because of all of the extra time and cost that must be devoted to commuting, infrastructure, and shipping.
Peace be to you all! I'm a new subscriber. In my opinion, this video was spot on!
You might mention what we family doctors refer to as "the deans' lie." Medical schools report on the number of their graduates going into residency in primary care specialties. In that number they include everyone going into residency for family medicine, internal medicine, and pediatrics. Of course a majority of internists and a large minority of pediatricians go on to sub specialize while the vast majority of family doctors enjoy careers in primary care.
Dang how does this only have 52k views! What a great video.
Since 1925 we have had a "doctor" shortage, Havard, Yale, Johns Hopkins want it this way.
Thank you for this video. Currently a Respiratory Therapist looking into becoming a PA. Looks like things will be looking good for that career field.
dragonmasterjg definitely go for being a PA. I'm a PA in family medicine, and it's a great job. PAs are in high demand where I live.
where do you live? in PA school now and have been thinking about what places are ideal to locate a job in
America should be more like the Uk. In the US, I heard paramedics can't do anything without asking a doctor first. Here, we have can have paramedics and nurses that can completely treat a problem on site and either get you to hospital or send you home.
Obviously, there needs to be a follow up doctor visit but that can be a local appointment rather than taking up more time at the hospital.
congratulations on your channel
Is there a way to not have the faint green vertical stripes behind Dr. Carroll flickering whenever he moves? (Are they real or SFX? Is that an odd compression artifact?) It's really distracting.
This great information. As of 2019, what is the data saying now in regards to physician shortage, med levels, distribution in healthcare delivery? I would love to know! Keep it up!
I do not think lowering medical school prices is going to necessarily solve the problem. As it is mentioned, the US has a fair amount of practicing physicians but most are in nice areas with a large population, because that is where they will get paid the most. Medical Schools are trying to get more of the students to practice in rural, medically underserved areas by offering them more money or student loan help, but sometimes the money is not worth it. Physician burn out is a real thing and it can cause physicians to stop practicing early or seek an easier life style. To clarify, physicians who work in medically underserved areas are most likely to live in less attractive, poorer communities or have a great distance to travel to work each day. They are more likely to have less coworkers, medical technology, and resources to properly treat patients and would need to work twice as hard as a physician who has multiple people to come in and take their shift. Those physicians who choose to live in the less served area are going to get drained from the work load and also from the fact that they will care and want to help patients so much, they will most likely be consistently disappointed from being limited by the resources available to them. If more physicians were rewarded for practicing in underserved areas, with a higher wage and better resources than maybe physicians would be more evenly dispersed throughout the country. Lots of physician's care and want to help the more rural communities but when the cost to them is less than the reward, you will see all of them go to the nicer, more populated, higher paying parts of the US.
Also, realize that, while I agree giving PAs and NPs provider status would make it better for patients, many doctors would then go out of business and also, very few would go into doctoring.
Lastly, they want you to think it's a distribution problem because the money that pays for more residency slots (and therefore more doctors) comes from Medicare and they aren't opening any new residency slots. So, the short answer: if you want the same personal medical care you're used to, you have to pay more or just deal. And this isn't going to end well for patients either way. Sorry.
Their training is substantially less in terms of depth of training and hours.
Giving PAs and NPs provider status is anything but better. This coming first hand from a medical student whos worked with PAs and NPs with "years of experience" and yet caught several obvious mistakes from them.
Love this show
I was genuinely surprised when he said that the United States only has 2.56 doctors per 1,000 people, which is much lower than a lot of other developed countries. I feel that if we are having a doctor shortage, it is the rising cost of tuition partly to blame, but not completely, because many students pursue the goal of going to medical school, and not all will be accepted due to competition. Therefore, people are still striving to become doctors, but due to limited spots in medical schools, only a certain number will be able to become doctors. However, reducing tuition costs would definitely help a lot of issues, especially the generalized vs specialized doctor ratio problem. I do think that perhaps taking the burden off of doctors, and giving more responsibilities to nurse practitioners and physician assistants will help make the health care system more efficient, but then I feel like salaries would need to change depending on the responsibility being exchanged between jobs. If health insurance is changing so that more services are required, and therefore more doctors are required, the medical schools should open up more spots for applying students in order to create more doctors and incentives should be placed for people to generalize, if that is truly what the US is lacking. However, I realize this is all very easy to say and very hard to actually do. Hopefully, the government will keep working hard towards improving the US' healthcare system.
I would have also liked to see how many hrs per week do they work as it directly relates to the subject at hand. Comparing ourselves to other nation could be pointless as the systems might not be similar or compatible for conparison.
you might appreciate my father's humor/advice (he's an oral surgeon) always see a specialist over a generalist.. they have better insurance. :-)
Good explanation
Great video.
ahospital where i live had as of a few years ago, an average wait time in the e.r of over 24 hrs. i dont think any country is happy with its health care system. we all want to snap out fingers and have everything done right then and there. heaven help us if we have to wait, even 45 min in a walk in clinic. we should be grateful that its not a 45 km walk to a clinic.
Yes, but you probably weren't paying the highest cost for health care in the world. What is frustrating in the US is that we are paying the most for very frustrating care.
Will you make a video on the nursing shortage? I don't think there's any controversy that one exists almost everywhere right now, and it's only going to get worse.
specialists do go through many more years of training however
Why not take a cue from he military. gov't pays for the medical school and then they own their ass for ~8 years where they work in places where services are needed. They get room and board and a modest salary. Grant grandfather options to existing medical people with similar terms.
The NHSC loan repayment option is exactly what you described.
Not to mention that the role of the pharmacist is evolving -- ambulatory care pharmacists, using an agreement with a physician, can see patients in a primary care setting and adjust medications. So there are definitely many more mid-level practitioners that can help with this problem.
You are right there, it's one reason i'm so interested in pursuing amb care post grad training.
As of May 4, 2024, the average annual pay for a Family Medicine Physician in the United States is $208,152 a year.
it's not worth it.
4 year undergraduate
4 year medical school
3 year residency for family medicine
The US has fewer practicing physicians per 1,000 people than 23 of the 28 countries. 2.56 doctors per 1,000. Lower than other countries. Invest in more physicians? We rely too heavily on physicians? Nurse practitioners? Distribution problem. Many rural areas have less physicians than other places. This problem can be fixed if students weren’t given $100,000 or more in student debt. It is hard to come out of debt, and this large amount scares many young students into wanting to go to med school. If tuition is lowered, we would be able to fix this. We also have too many specialists. They make more money when there is a specialist, and this is what most people are doing. But it is difficult for people in smaller towns to find a general doctor, because there are not as many general physicians. They could decrease amount of students that go into specialization.
The average medical school debt is $202,453, excluding premedical undergraduate and other educational debt. The average medical school graduate owes $250,995 in total student loan debt. 73% of medical school graduates have educational debt.
It's interesting you mention Canada. The city I live is desperately in need of doctors. It's genuinely unacceptable how little health care is available for the size of the city. I'd love to know what can be done about it. Is it also a dispersion problem? Maybe this is something Canadians need to start shouting about.
Agreed with most of what you had to say, but I wouldn't call any of my nurse practitioners "mid-level providers." It's demeaning, similar to the family med/pediatric field in the physician world. No need to separate them from us any further. Let's call them what they are: healthcare professionals.
There is a shortage of Providers, because they are not getting the reimbursement they are entitled to. A PCP may bill out $245k/yr. But he or she will only get a fraction of that (healthy $$$ tied up in A/R). Due to:registration errors, credentialing issues, Payor reimbursing the negotiated rate - if they decide to pay, uncapture charges due to the newness of the Int’l mandate of ICD-10 & PCS; info not interpashing correctly between systems, etc. And a lot of them don’t like NOT being held to a certain disposition. Than how they use to be back in the day. Administration & the Major Medicals have more control in how they deliver care. And the Docs don’t like that.
Many people are attributing this shortage to medical school cost. Could something like that be goverment funded too?
What about doctor bots? As far as I'm aware AI doctors could very easily replace most GPs or at least decrease the need dramatically. I'm not very knowledgeable about this, but I'd love to hear from someone who is.
No, it does not "follow that we can only fix this by training and hiring more physicians".
Not even close.
Different levels of care is a start, the average nurse practitioner I have met is at least as capable as a doctor in 9 out of 10 cases. Distribution needs to be addressed on a fundamental level. Though the elephant in the room, and the one I cannot believe you earnestly overlooked, is the amount of not-doctor-work that literally every single doctor I have ever known regularly performs. I've witnessed firsthand MDs making schedules, navigating the many pitfalls of our idiot insurance system, performing employee evaluations, serving nearly full time in administrative roles, scheduling appointments, and a whole host of other tasks which could be performed by someone with basic education OR (perhaps even worse) probably better by someone with a specialty/degree that is not even in a medical field. The causes have ranged from being overly controlling to poor management (another favorite not-saving-lives activity for many doctors. Hire an MBA already) to unstaffing to a somewhat misplaced sense of being polite. Medical doctors should be treating people or advancing the science of medicine, not approving the fucking cafeteria schedule. It is quite frankly insane. If I knew a mechanic who spent as much time not-fixing-cars as the average doctor spends not-treating-people I wouldn't even call them a mechanic.
This is very true, particularly in hospital settings but part of that is the insurance system we have in place. The family and I can put in 15 calls to an insurance company trying to get approval for a procedure/drug a physician prescribed but they will stonewall until the actual doctor takes the time to call in and complain. It is incredibly frustrating for everyone but the insurer who knows how many times patients, families, nurses and doctors just don't have the time to waste.
Thanks ihartevil- for proving every criticism of Bernie Bros was spot on! And I say this as a born and raised Vermonter/ Bernie supporter who was constantly fighting against you idiot Bernie Bros who pushed away potential supporters by the bus load- if he couldn't fight the DNC and win, their is no way he would beat Trump.
You must be an enormous idiot if you believe NARAL would give a 100% rating and the endorsement to a candidate who supports criminalizing abortion. Another zero information voter for Trump. Don't bother replying moron- I'm done with the short bus voters like you.
cminmd0041 Counterpoint: Using your own logic- If Hilary couldn't win the DNC without cheating...
52k? That's it? Omg in Australia interns make 80k and residents 90k+. At least that's what my cohort was told by the dean of the medical school at the university of Melbourne.
Between Canada and the US it is barely a different.
People need to get out of cities that is what he is saying.
I would've gone the MD route instead of DNP if med school wasn't $50k/year. As a DNP I'll be able to do just about the same thing, but my tuition will be much less.
I wonder if the people who make these health care laws and reforms have someone like you to consult on what the real issues of the system are. With the way that politicians complain about the current health care system it would seem that no one in the medical field has ever been consulted.
Totally agree! Obama even never bother to go to check doctor opinion
Art of street work out ....I don't mean Obama specifically. I mean politicians in general. It is politically favorable right now to bash Obamacare, but I'd like to see what these politicians think to replace it with and how close it comes to addressing real problems with the system. I'd like to know if they have actual medical consultants who have looked at actual research to try and fix the root cause of the problem instead of just slapping another bandaid on it.
Obama did check with physician's on health care reform. Dr. Atul Gawande's writings were highly influential on the reform bill.
Obama tried to do what's best for everyone, but unfortunately that doesn't make the other politicians rich "enough" unfortunately for their tastes. They see medicine strictly as a business and want to pay as little as possible while asking physicians to do superhuman and now impossible tasks both with regards to quality and quantity of care per day. It all is actually both complex and simple. Most of it goes back to money. Most doctors just want to help patients and reimbursed "appropriately" for their 15 year sacrifices. The politicians are just trying to squeeze doctors dry.
In my experience in studying in EU while we know that US doctors are paid better (some of the time at least) than we would be in many places in europe, many of us also think of the US system as being a bit unethical, what with all the stories of people being kept on treatments for longer periods to raise their medical bills, prescriptions of drugs that don't really help because you're on some pharmaceutical payroll and A HOST of other reasons.
Many of us younger (and granted millennial snowflakes) feel that this immorality of the system is so high that we don't want to get involved, of course most of us have no idea what the hell we're talking about... we're med students not doctors, and many of us have had no personal experience with the US medical system... so... u know.. I might just be talking out my ass here
We could make rural areas more appealing to doctors but that won’t happen
Do Americans want generalists though? Americans believe in individuality and their ability to choose which doctor to see.The lay person would prefer a specialist who can do complicated procedures such as MRIs and CT scans and "get the job done faster" rather than to see a general doctor; this could also be a potential reason why there are so few generalists compared to specialists.
This is not likely the case. Most specialists in the US see patients thru the referral process in which a generalist first assesses the patient and makes the decision that the patient will likely require an elevated level of care. Sure, a consumer can make the decision to see that a specialist i.e. a cardiologist at first opportunity, but this is not something that all insurance programs cover.
Secondly, NO specialized Internal Medicine doctor or Generalist performs their own MRI or CT. They will have the patient directed to a radiology department, where the appropriate test will be performed and the patients imaging will be read by a radiologist. Some CT and MRI are located in House or the clinic may be in close proximity to a hospital with a fully staffed Radiology Suite, but for the most part, the speed the test can be obtained for both specialists and generalists is same. Generalists tend to be less willing to order mainly due to the cost, as MRIs can have cost that can exceed 3000 dollars. The patient will likely not see the cost, they will just pay their deductible, but the insurance company will bear the fiduciary burden, thus increasing the cost of the health care system at large.
The reasons for the trend towards specialization are primarily financial. Prestige is also as a strong motivating factor as the graduating as a cardiologist with an excellent academic record is a much more palatable than graduating after 3 years of internal medicine residency to deal with the seemingly mundane problems seen in primary care medicine. Combine this with the fact that a New cardiologist can stand to make 350,000 coming out of fellowship, vs a Generalists whose median pay is between 180,000 and 200,000 dollar; the decision to specialize becomes easier.
U need to visit generalist first who then recommends a specialist. If u go do specialist he will see ur problem from their perspective and can be misdiagnosed.
Individuality has nothing to do with choosing between generalist or specialist. It's a medical decision. Individuality would be choosing between hospitals or between same type of doctors.
I think he just described the plot to "Doc Hollywood"...
greetings from austria
ill be honest, im 31, millenial, born on 1991... i know a lot of people. i dont know a single peer who became a doctor, not one. problably like 5 nurses or more... no doctor, not one.... from all my peers ive ever known.
Is becoming a Nurse Practitioner worth it?
PaulDaPsycho1 probably the best of the three choices (PA, Np, MD/DO) Because you have multiple levels of advancement, increasing pay, many fields to go into, and time to decide when and where you want to stop (with your education) Also, high demand obviously. It depends on the individual, so talk with an advisor but that's my perspective.
83 million millenials will not be able to serve and support 70 million retired babyboomers plus the 83 million millenials and children. Expect massive labor shortages, not only in the medical field but other industries as well. This will also happen in China, Europe, the middle east, Russia. It will also happen in Latin America, Africa to a lessor extent.
Can we fix this by increasing medical school graduates? Accepting more into medical schools? Building more med schools if necessary and accomodating thousands of new medical students each year could help. Any downfalls to this? We could use the 10 trillion dollars we waste on wars and weaponry to improve healthczre
As Dr. Carroll pointed out, US med schools turn out specialists not generalists. Building more med schools will turn out even more specialists. We need to change med schools and incentives to produce more generalists instead of building more med schools that will just keep doing what they're doing now.
Lowering the cost of education would be the single easiest way to increase the amount of doctors.
Combined with some marketing for the generalist occupation and viola.
Training new doctors is not an efficient way to solve the shortage. Yes, I agree it could help, but there are better ways to do so. Everyone who wants to become a doctor can. There's not really a way of getting new doctors without forcing people to pursue that career. If schooling was made shorter and we pushed new doctors out faster, they wouldn't be ready for their new jobs. We could make schooling cheaper so medical school becomes doable for more people, but these medical schools only allow a certain amount of students in anyways. I understand why we pay doctors who live in more expensive cities more, but I don't think it is actually helping us. I agree that we need to work on distributing our goods. Maybe we could pay doctors more who live in less desirable areas. Allowing mid-level practitioners to do more work would also be a great way of stopping the shortage. Balancing the work load out seems like a very good first step. There is some controversy to this though. If we allow practitioners and physicians to do basically the same work, but pay the physicians more how is this fair? If we balance their pay physicians will only become practitioners because there is no real benefit anymore. Thus increasing the physicians shortage even more. There doesn't seem to be one good answer to stopping the shortage, but a collection of little things.
Its crazy how super selective medical school is and so many people are qualified to become doctors and yet there is a shortage??? Wow
"Based on these metrics" of comparing per capita docs to other countries....may be a mistaken way to compare them.
so the right way to compare is...?
TheQuetzalcoatl Why are they correct when the differing population sizes plays a large part? What is the right number of docs? How many is too many? How do you just snap your fingers and increase pay for general practitioners?
Physician: Look at all the problems with medical care in America. We could fix that!
Economists: Have you considered that all of problems you brought up were previously 'fixes' that 'required government to act'?
Physician: Hey let's not just give up on tinkering with the economy. This time is different, and besides the economy isn't as complex as the human body! I know how to fix this better than you because I have an expertise in a subset of the problem in question.
Doctor immigration would be good, but the worry there (baseless or not) is that they're not up to the same 'standards'.
Personally and anecdotally, my doctor is from India originally and is amazing. but I'm also a healthy(mostly) male in his 30's so definitely have a skewed outlook on this.
I'm training to be a doctor in the US (about to graduate) and have worked with many foreign doctors here in the US. They have to take all the same licensing exams as us in order to practice in the US, then complete residency training here just like we do.
Any foreign doctor training here is the cream of the crop. Academically, they are held to much higher standards than I have been through medical school. They have to perform much much higher on the same exams in order to get the same residency spot as me.
But the problem is not a doctor shortage- but a distribution problem. Some foreign doctors can be persuaded to service remote, poorly served communities in exchange for H1B/ immigration waivers but usually only for a short time. Then all the incentives are to "follow the money" like every other doctor. We need to stop financially rewarding physicians in a way that exacerbates the distribution problem.
To increase income, GPs can be better about merchandizing with quality supplements and promoting wellness services 🙏💙
I want to be a doctor however I lack social skills
It's too hard and expensive to become a physician. I prefer to become a human biologist
Good luck being unemployed...
Most of the major problems in the world are about distribution, not shortage. Food, healthcare, safe water, energy, social security, you name it! Guess what, there is one political-economical system that directly opposes equitable distribution. Sounds familiar?
but they eeeeaaaaarrrrrrnnnnnneeeeeeeddddddddd it.
The doctor shortage will get much worse, it has to do with shrinking U.S. demographics and rising tuition costs. It's mathematically impossible to fill all the doctor slots being vacated by boomers. Add to this rampant discrimination against minorities and it only compounds the problem.
You got your discrimination mixed up
Expected and failed.
Ill be a doctor in india. and will come us soon.
The doctor shortage is real . In Independence, Mo on Noland rd the waiting period to see a doctor is 4 months
Money is always the reason.
Frankly let’s do what we do in other industries just import them
Well, bring in Swiss/German/Sweedish/Norwegian/Austrian rural doctors/nurses/etc over. Problem solved! Everybody's happy!
(Except Homeland Security)
3:51 Greece a developed economy lol
You'll be dead before you see the doctor but right on time for the mortician
Your logic is wrong. If we had to many doctors in cities, that would mean cities are full of unemployed doctors. What we have is to many specialists. Every other major country has half its doctors in primary care. We have only 9% of doctors in primary care.