Do we need more doctors?

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Is there a doctor shortage?

Definitely - we need more MDs
12
57%
No - we need more nurses not more MDs
2
10%
More primary care physicians needed
7
33%
More specialists needed
0
No votes
 
Total votes : 21

Do we need more doctors?

Postby Adminnaoum » Wed May 13, 2009 4:01 pm

The debate over whether there really is a physician shortage is starting to heat up.

A commentary in CNN makes the argument that we don't need more doctors, instead primary care should be shifted more to nurse practitioners:

However, we submit that these actions lead us in the wrong direction, and there is, in fact, no doctor shortage -- as long as we accept the fact that health care can work differently, and better than, the current system.


What's your take on this issue?

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Re: Do we need more doctors?

Postby gburana » Wed Apr 21, 2010 11:43 am

I think that we need more doctors. People are beginning to live longer and the population is steadily increasing. Simple supply and demand. This in itself justifies the need for more physicians.

On another point: given the high percentage of people who are already not receiving health care and the recent changes in Obama's health care plan to require everyone to take on some type of health insurance, the demand for doctors is only going to increase. If we simply increase the number of nurses or nurse practitioners, then doctors will have much less patient contact and increased paperwork. Doctors will be required to sign off on all of the new nurse practitioners under their care and also take more risk for malpractice suits. More patients will be under a doctor's care, but they will see even less of them personally.

I do not mean any offense towards nurses, because I know a lot of very intelligent and capable nurse practitioners, but what we need is more primary care physicians. Also, there should be more incentive for doctors to become primary care physicians. This would help solve part of the health care dilemma by meeting the demands for more accessible care and maybe entice more individuals to pursue a career in medicine.
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Re: Do we need more doctors?

Postby IMNOTDRPHIL » Wed May 19, 2010 2:46 pm

Adminnaoum wrote:The debate over whether there really is a physician shortage is starting to heat up.

A commentary in CNN makes the argument that we don't need more doctors, instead primary care should be shifted more to nurse practitioners:

However, we submit that these actions lead us in the wrong direction, and there is, in fact, no doctor shortage -- as long as we accept the fact that health care can work differently, and better than, the current system.


What's your take on this issue?

drn


The people that wrote that book discussed in the CNN article are at worst merely incorrect and at worst absolutely misleading. I'll bring up a few points.

If job satisfaction were really the issue, we'd see people avoiding orthopedic surgery, OB/GYN, ophtho, hospital internal medicine, and ENT. All of those except for hospitalist are some of the specialties students seem to love to go into (especially ortho and ENT) and none are primary care. The happiest physicians were in pediatrics, geriatrics, neonatology, and derm. Pediatrics and geriatrics are the biggest components of primary care. So, it obviously isn't job dissatisfaction causing people to not go into primary care. Everything I've seen points to lower pay and lower prestige being the pain factors.

The article says that algorithms and EMRs can basically replace clinical knowledge and experience and allow people with less training to do more specialized work. Anybody who's actually been in a clinical setting for very long will tell you that doesn't usually work very well. Sure, it would work reasonably well with patients who are textbook cases. But generally the only time you see those is when somebody screwed up and let a nonspecific early presentation of a disease go untreated (or improperly treated them) and it progressed into a fulminant textbook case and the patient is in far worse shape. For example, necrotizing fasciitis is easy to diagnose when the patient has large areas of skin sloughing off them. However, they stand a much better chance of living when an experienced physician sees a patient who has a little too much pain for the relatively mild swelling/redness, suspects necrotizing fasciitis, and starts them on antibiotics STAT. Even with all of the technology we have now, medicine still has a lot of "art" of being able to recognize situations and think of things outside of the algorithm box.

The article does not address the reason why seeing an NP for certain conditions is less expensive than seeing an MD. Seeing NPs instead of MDs is basically an arbitrage against laws mandating licensing requirements, education requirements, and legal liability. Anybody who has taken Econ 101 (and I would assume somebody with an MBA worth the paper it's printed on would have taken it) knows that arbitrage is a temporary condition that the market will correct. People will expect NPs to do more things than they currently do, which will mandate more training. NPs are human like anybody else and with greater autonomy, their mistakes will be increasingly seen as their own (instead of being the responsibility of the supervising MD), and they will have greater liability exposure. So after a period of time, you will have turned NPs into what primary care MDs were, complete with the same expenses- and you'll pay the same to see them because of this.

My real $0.02 about the issue is that we need to tackle the reasons why it is so expensive to see a primary care MD and attack those instead of trying to temporarily skirt the problem. However, those problems are far more difficult to address and will step on toes of people with far more political clout than doctors have, so few want to tackle them. Case in point: notice how tort reform is not mentioned anywhere in the healthcare reform bill? That wasn't accidental.
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Re: Do we need more doctors?

Postby Enot » Tue Jun 08, 2010 7:26 am

Excellent well formulated response. I agree with you. I have little to add, but I feel that your statement deserves some applause.
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Re: Do we need more doctors?

Postby CaribMD » Tue Jun 08, 2010 9:56 am

IMNOTDRPHIL wrote:
Adminnaoum wrote:The debate over whether there really is a physician shortage is starting to heat up.

A commentary in CNN makes the argument that we don't need more doctors, instead primary care should be shifted more to nurse practitioners:

However, we submit that these actions lead us in the wrong direction, and there is, in fact, no doctor shortage -- as long as we accept the fact that health care can work differently, and better than, the current system.


What's your take on this issue?

drn


The people that wrote that book discussed in the CNN article are at worst merely incorrect and at worst absolutely misleading. I'll bring up a few points.

If job satisfaction were really the issue, we'd see people avoiding orthopedic surgery, OB/GYN, ophtho, hospital internal medicine, and ENT. All of those except for hospitalist are some of the specialties students seem to love to go into (especially ortho and ENT) and none are primary care. The happiest physicians were in pediatrics, geriatrics, neonatology, and derm. Pediatrics and geriatrics are the biggest components of primary care. So, it obviously isn't job dissatisfaction causing people to not go into primary care. Everything I've seen points to lower pay and lower prestige being the pain factors.

The article says that algorithms and EMRs can basically replace clinical knowledge and experience and allow people with less training to do more specialized work. Anybody who's actually been in a clinical setting for very long will tell you that doesn't usually work very well. Sure, it would work reasonably well with patients who are textbook cases. But generally the only time you see those is when somebody screwed up and let a nonspecific early presentation of a disease go untreated (or improperly treated them) and it progressed into a fulminant textbook case and the patient is in far worse shape. For example, necrotizing fasciitis is easy to diagnose when the patient has large areas of skin sloughing off them. However, they stand a much better chance of living when an experienced physician sees a patient who has a little too much pain for the relatively mild swelling/redness, suspects necrotizing fasciitis, and starts them on antibiotics STAT. Even with all of the technology we have now, medicine still has a lot of "art" of being able to recognize situations and think of things outside of the algorithm box.

The article does not address the reason why seeing an NP for certain conditions is less expensive than seeing an MD. Seeing NPs instead of MDs is basically an arbitrage against laws mandating licensing requirements, education requirements, and legal liability. Anybody who has taken Econ 101 (and I would assume somebody with an MBA worth the paper it's printed on would have taken it) knows that arbitrage is a temporary condition that the market will correct. People will expect NPs to do more things than they currently do, which will mandate more training. NPs are human like anybody else and with greater autonomy, their mistakes will be increasingly seen as their own (instead of being the responsibility of the supervising MD), and they will have greater liability exposure. So after a period of time, you will have turned NPs into what primary care MDs were, complete with the same expenses- and you'll pay the same to see them because of this.

My real $0.02 about the issue is that we need to tackle the reasons why it is so expensive to see a primary care MD and attack those instead of trying to temporarily skirt the problem. However, those problems are far more difficult to address and will step on toes of people with far more political clout than doctors have, so few want to tackle them. Case in point: notice how tort reform is not mentioned anywhere in the healthcare reform bill? That wasn't accidental.


The problem with people not in Advanced practice in medicine is that they see RN's as almost Doctors, so NP's are Just like Doctors, despite the training is different and the experience level greatly fluctuates between one NP and another, they are trained in specialties and are not to practice outside that scope.

MDs / DO's have greater scope, longer training, well rounded focus, hence even in specialization a Plastic Surgeon for instance has delivered Babies and assisted in Bowel surgery as well as taken care of High blood pressure. This makes them better suited for overall care of a patient VS a one focused practicioner. When it comes down to it, people want a Doctor when they have a complicated problem not a NP or PA, I hear it all the time. MD's and DO's spend twice the amount of time in training and school compared to NP and PA's, they are not the same and not "Just as good". I'm not saying NP's and PA's are not skilled and valued, they are,but there is a scope of practice.

NP's and PA's should continue to be under a physician its safer and only makes the care better, I fail to understand why some peopl in the public want to water down the care to unsafe levels (Unless the insurance companies are involved) :?: :?
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