Dr. Val left a comment to my last post which, as I composed a response, started getting longer and longer and morphed into a post in its own right.
Just wondering what you think of the physician shortage and what that would mean for a universal coverage system?
Also - PandaBearMD had an interesting story about a patient who came to the ER for mild constipation. He believes that the primary problem with the healthcare system is human stupidity, enabled by malpractice attorneys. :)
As an intern, I once saw a recent immigrant who believed that not having a bowel movement for a day was not normal. He also was accustomed to going to the hospital for all medical care. He turned up in the ER with a chief complaint of constipation.
Yep, it's pretty frustrating. People don't behave in ways that the educated and informed consider smart. Even intelligent people without the help of a malpractice lawyer can behave in a self-destructive manner. We are in a position to help and contribute something positive in people’s lives but often find our time wasted.
It is not an efficient use of our skills and is particularly frustrating if we feel poorly remunerated.
As for the physician shortage, I’m glad you reminded me, Val. Sometimes I’m not too bright. One of the greatest impracticalities of widening coverage for the uninsured is that we don’t have enough docs to take care of all these people. This shortage is especially acute in primary care.
The remarkable shortage of primary care docs extends to certain specialties. Usual market forces of supply and demand do not apply simply in health care. More doctors create more demand. One more reason the mantra of “access, cost and quality” is absurd.
Increase access and you increase cost. There may be savings to be had in reducing inefficiencies and preventing complications, but they can never realistically cover the entire increase. Improving process quality may reduce some additional inefficiency, but health outcome quality derives from patient behavior as well and thus is much more difficult to change with health care delivery interventions.
We need more doctors, especially in primary care, used efficiently (focus on process quality), extending coverage to those in greatest need and the simple acknowledgment that it will cost a lot of money. So why is Medicare cutting physician reimbursement? Well, that's another post, isn't it?
What is the reason to spend so much money covering the unwashed, uneducated, self-destructive mass of humanity?
Because it’s the right thing to do.