America’s aging population is leading to a doctor shortage crisis

https://www.cnbc.com/2019/09/06/americas-aging-population-is-leading-to-a-doctor-shortage-crisis.html

by spking • 7 years ago

56 49 7 years ago

Madmallard• 7 years ago

Nope there's no doctor shortage. There is hospital administration greed and crappy working conditions where patient throughput is valued above all else leading to doctor burnout. I am angry at whomever wrote this for fueling the wrong argument and possibly trying to detract from the real issue.

SkyPuncher• 7 years ago

The doctor shortage isn't really about hospitals.

It's a huge issue with family and primary care physicians, particularly in rural areas. Paper work requirements and misguided reimbursement goals are making it unsustainable for doctors not involved in large health systems.

zelon88• 7 years ago

Well the medical debt bubble has gotta burst eventually. My guess is right before it does the state of healthcare in the US will be so bad that women will be giving birth in minute clinics because everyone will be priced out of hospitals by then. We won't have a shortage of anything until we fix our shortage of insurance providers.

NTDF9• 7 years ago

Rural America really really needs more doctors. The amount of time it takes to get an appointment to diagnose anything is crazy long already.

dantheman2• 7 years ago

The doctor shortage has to do with the American Medical Associate (AMA), a cartel, that successfully lobbied to reduce the number of residencies available for doctors. They also make it difficult for new medical schools to be created -- this is intentional, since as a cartel they want to limit the number of doctors so that they can demand hire wages.

https://www.forbes.com/2009/08/25/american-medical-associati...

EGreg• 7 years ago

And yet people like Ben Shapiro continue to insist that it is single payer that will lead to less doctors...

If doctors collectivize, then shouldn’t patients?

dantheman2• 7 years ago

I think it'd be best if we removed the power of the AMA; allowed the ability to fast track foreign medical staff (doctors, nurses, specialists).

Allowed medical schools to control their curriculum more, allow new ones, change the residency system.

One simple change would be to create a 6 year BS/MD degree that students could start directly from high school -- many other countries do this.

lucifirius• 7 years ago

Single payer in the UK has already led to doctor shortages, so I'm not sure what point you're trying to make.

There's many ways to get to a shortage, cartels and single payer are but two.

lettergram• 7 years ago

Came here to say the same thing. They were intentionally (and arguably still are) limiting the number of doctors admitted to medical school and number of graduate/medical schools.

https://skeptics.stackexchange.com/questions/4561/does-the-a...

devoply• 7 years ago

I also heard that doctor's salaries in general are significantly impacted by hospitals and insurance companies and it's hard to make the same sort of money now as you could in the past. Is there any truth to this?

mrep• 7 years ago

I don't work in the healthcare industry so I have no skin in the game, but in what situations do you consider labor cartels ok because unions are exactly that and many people here seem to advocate them. Becoming a doctor from what I have read sounds like a horrible return on investment: You have to delay real wages for like 8 years while you get educated, those 8 years make you massively in debt, once you become a doctor, you have to pay off those 8 years of debt while also paying massive insurance rates. I'm not suprised doctors are trying to secure some wages after 8 years of investing in themselves while going massively in debt.

zanny• 7 years ago

I doubt many on HN of all places are for legally mandated unions, which are the ones that produce true cartel like behavior. Most unions maintain authority through their collective bargaining alone - to abstain from the union would mean the loss of most of your workforce, and thus you must negotiate with the union.

Except if you want to call unions cartels because they negotiate on behalf of their members with employers than anyone trying to barter in business is engaging in cartel like behavior. Its deconstructive because in practice unions only exist to counteract the power imbalance between worker and employer. A cartel in business forms not to counteract power imbalance through collective action but to monopolize existing power.

You might call those origin points irrelevant but they make the world of difference to me. In the absence of unions labor is almost universally exploited. In their presence, businesses are hopefully and sometimes forced to bargain on more equal footing. Thats a net benefit. A business cartel likewise exists to imbalance what was closer to equilibrium and thus is a net negative.

wolco3• 7 years ago

The 8 years could be streamlined but it's setup to weed out many and tire out the remaining. Many of the brightest most curious people get turned off by the process the people that remain are the ones who could stand the beatdown. Then they get out start working and have to see 25,000 people a year (100/day) as a gp.

There is a huge burnout process going on. I see so many doctors try to make a business on shark tank/dragons den work or they try to become media personalities.

Many seem stuck because the job isn't what many would expect. They have invested heavily time/effort in study, they have high debt and they have increased expectations from family/community.

TuringNYC2• 7 years ago

Plot a graph:

1970 to now: US Population (or US senior citizen population)

1970 to now: Medical schools

1970 to now: Medical school graduates

1970 to now: Medical Resident spots for "shortage" specialties

I'm willing to bet the shortage is due to these plots not growing proportionally. Also, you cant increase medical school graduates w/o also increasing resident spots, otherwise, graduates go into other fields.

cybersnowflake• 7 years ago

Yep, everybody and their mother that I went to school with aspired to become a doctor. There should be absolutely no shortage. Getting to more reasonable numbers doesn't seem like it would worsen the already abysmal quality we're getting now with sleepwalking insanely overworked physicians.

TuringNYC2• 7 years ago

> Yep, everybody and their mother that I went to school with aspired to become a doctor. There should be absolutely no shortage.

There is a shortage...sort of...there is a very limited quota of Medical Resident spots opened up by various AMA medical boards (read: cartel.) There are a line of aspiring physicians, but they can only practice as board certified specialists if the boards open up seats, and there is a forced constrained supply (probably to increase wages for those inside the club.)

HillaryBriss2• 7 years ago

the real genius of the AMA was finding a way to drastically slow the global MD population as it tried to correct the imbalance by entering the US and setting up practice.

anovikov• 7 years ago

Maybe they are doing it for a reason? Suppose you are 16 now and choosing a profession. Due to exceptionally long training times for doctors, you will become a doctor so will make good money, by 30, which will be in 2033. By then, most boomers will die off and the demand for doctors will collapse, so you will find yourself will a million dollar student debt and no prospects of employment good enough to repay it.

It's cyclic.

user59944613• 7 years ago

Most of the doctors are boomers themselves and getting retired, or dying as you said. The shortage is not about to get better.

pvaldes• 7 years ago

you will find yourself will a million dollar student debt

In USA. Definitely not in EU (currently, although there is a increasing pressure to dismantle and privatize university)

On the other hand, robotic solutions are competing for more and more roles in Hospitals. We have robotic helpers for surgeons yet. At some point in the near future they will start replacing many people and this factor should be included in the picture. Specialists will do online surgeries in all country without spending the time traveling from one hospital to other. The future can need less doctors for treating the same people.

runamok2• 7 years ago

And they actively prevent nurse practitioners and nurses from performing many functions they're perfectly capable of doing.

yumraj• 7 years ago

Such as?

bluedino• 7 years ago

What is the reason for so many doctors coming to the US from India and the Middle East?

pinacarlos90• 7 years ago

Is it just me that feels like recently the word “crisis” is being overused? not just online but by the media also

taxicabjesus• 7 years ago

The doctor shortage would be lessened if medical resources were allocated more intelligently. As it is, doctors have a tendency to make work for themselves. The system needs lots of doctors simply to keep their charade going.

We all get to a point where we need less doctoring, not more. During the 'obamacare' debates some stupid politicians called this transition in the goals of treatment "death panels" [1], but the realists on the other side of the aisle didn't figure out how to intelligently point out that sometimes letting people die gracefully is kinder than subjecting them to every possible medical treatment.

My brother works with old people in Arizona. He's paid a salary, and makes a game of trying to spend his employer's resources efficiently. On a recent visit I noted his comment about how he's just doing palliative care. Most doctors aren't on salary, and are paid via the standard medicare "fee-for-service" (FFS) [2] model, which is a good way to make people profitable to their medical providers.

[0] My earlier comment about my mom's elderly friend's predicament: https://news.ycombinator.com/item?id=20224523

[1] https://en.wikipedia.org/wiki/Death_panel

[2] https://en.wikipedia.org/wiki/Fee-for-service

fhsm• 7 years ago

Shouldn’t this point to the actual report not thin reporting on its publication?

https://news.aamc.org/content/downloadable/209/ [PDF, by way of CDN redirect]

Or at least the (interested sponsors) press release on the study linked in this news article?

https://news.aamc.org/press-releases/article/2019-workforce-...

Merrill• 7 years ago

It appears that Medicare keeps the fee for an office visit low. This causes the doctors to schedule frequent, short exams. They also do frequent diagnostic tests to increase revenue per visit. Less frequent, more thorough visits would seem to be more efficient for all.

Lots of senior care is pretty elastic, since most visits result in no change in drugs or procedures for the patient. They are simply monitoring chronic and/or progressive conditions.

America’s aging population is leading to a doctor shortage crisis

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