U.S. will be short 63,000 doctors by 2015. Your health care is covered, but who’s going to treat you?
– CNN, 2012
Nurse practitioners will provide complete physical exams, diagnose many problems, interpret lab results and X-rays, and prescribe and manage medications.
– Los Angeles Times, 2012
What if nearly half of all physicians in America stopped practicing medicine? While a sudden loss of half of the nation’s physicians seems unlikely, a very dramatic decrease in the physician workforce could become a reality as an unexpected side effect of health reform.
− Andrea Santiago, Medicus Firm study, 2010
With apologies to Bruce Springsteen, all this can be summed up as follows:
I’m going to get bad health care
But at least I think it’s free.
Let me ask some key questions:
● Would you give up major parts of your childhood and youth to intensive study?
● Would you spend one-third of your life in school and training?
● Would you saddle yourself with hundreds of thousands of dollars of school-loan debt?
● Would you go through four, five, or more years of postgraduate training, with sleep deprivation, job stress, and strict discipline, as well as unpleasant sights, sounds, and smells?
● Would you do all this, only to end up a virtual servant, following unrealistic, confusing, and often contradictory directives from non-medical government bureaucrats?
● Would you resign yourself to a life of less professional independence, less human satisfaction, and less income?
● Would you relegate your patients to inferior care dictated by bean-counters and paper-shufflers who have little medical knowledge, but from whom there is no appeal?
● Or would you opt for a more rewarding career, leaving sick people to be cared for by doctors trained in other nations, as now is happening in Britain?
True, there will always be some who are so highly motivated that they would pursue a career in medicine, no matter how strong the disincentives. But a system cannot depend on exceptional people to keep it running.
An army that relies on most of its soldiers being Medal of Honor recipients is unlikely to win wars. A health-care system that depends on most of its physicians being saintly altruists is unlikely to provide optimum care.
On the contrary, saintly altruists would not want to be government stooges in a rigid, mechanical system, and might become medical missionaries in some third-world nation. There they could fulfill their desire to serve humanity, unfettered by pencil-pushers armed with the power of the state.
Does this picture seem too bleak? Read the survey. In all, 1195 physicians in various specialties, various stages of their careers, and various locations were included. The results are depressing. Almost one-third said they would leave medicine if ObamaCare went into effect. Even worse, almost half (46%) of primary-care physicians (family physicians and internists) said they would leave medicine. Primary-care physicians are already in short supply.
The same shortage is faced by nursing. Years ago, “experts” closed almost 90% of three-year nursing schools. Now we must import nurses from abroad, some of whom barely speak English. So much for the ability of “experts” to manage professions of which they know little.
What did we expect? We increased the length and cost of nursing education, and we decreased the satisfaction of a nursing career. We have already increased the length and cost of a medical education, and ObamaCare will further decrease the satisfaction of a medical career. Then we will need to import doctors as well.
The population is growing and also aging. Even without ObamaCare, the number of physicians will have to increase sharply just to maintain current levels of staffing. The Bureau of Labor Statistics predicts a 22% increase in physician jobs between now and 2018. Medicine ought to be one of the most rapidly growing fields.
But talk to older doctors. Many will tell you that they intend to retire as soon as it is financially feasible. They are tired of fighting for reimbursement − from private insurers, and especially from Medicare and Medicaid.
More physicians are opting out of Medicare. They endure endless resubmissions of claims, endless denials, and endless appeals − and even demands for refunds months later.
● Question: How much of the Medicare “waste, fraud, and abuse” that President Obama talks about actually represents valid claims for needed treatment that were arbitrarily denied?
● Question: If an insurance company denies a claim, it is a coldhearted money-grubber. But if the government denies a claim, it is uncovering “waste, fraud, and abuse.” How’s that for an objective evaluation of the problem?
So you still think rationing of care isn’t coming? Check out these two news stories:
Government committee recommends that men not get PSA tests to screen for prostate cancer.
– CBS News
Without PSA screening, prostate cancer will cause about 17,000 additional deaths annually.
– Cancer, a journal of the American Cancer Society
PSA screening resulted in early detection and cure for prominent people from New York Mayor Rudy Giuliani to Los Angeles Cardinal Roger Mahony, as well as others including Gen. Colin Powell, Gen. Norman Schwarzkopf, and Sen. John Kerry. But it’s not “cost effective” for the rest of us. Really?
About one-third of physicians say they will leave practice if ObamaCare goes into effect. Some may not carry out their threat. But others, who do not now intend to leave medicine, will do so if they find a government-run system unbearable.
ObamaCare does nothing about curbing malpractice suits or reducing the cost of malpractice insurance. What do you suppose will happen if bureaucrats deny a treatment? If the physician withholds it, the patient may sue him. But if he provides it, he may be charged with “waste, fraud, and abuse.” We will be combining the worst features of government medicine with the worst features of private medicine.
Under ObamaCare, millions of people, including illegal immigrants who now get mainly emergency care, will become eligible for more care. But ObamaCare does not provide one penny to train more doctors, nurses, or medical technicians. Providing more care to more people for less money − and with no more or even fewer physicians − may make an attractive campaign promise, but it makes no sense at all in the real world.
It does not take psychic powers to predict that more people seeking more care from too few providers will surely result in long waiting lines, delay of needed treatment, rationing − and therefore unnecessary suffering, disability, and death. But to a leftist, what matters is not quality of care, but equality of care. A leftist would be happy if everyone got the same level of care, even if that level were second-rate.
Leftists praised health care in the Soviet Union, but how many new drugs did it develop in its 74 years of existence? I can’t name one. In contrast, the United States, with only 4% of the world’s population, earns over 60% of the Nobel Prizes in Medicine. They are earned by Americans, but also by foreigners who come here because of the congenial environment for research. I doubt that the quality of health care in general, and research in particular, will remain high under a government-run system.
And what about the quality of those who go into medicine? Now dedicated young people apply to medical school, hoping to become independent professionals, using their best judgment for the benefit of individual patients. But who will apply when graduates become functionaries, required to follow cookbooks (excuse me, “algorithms” and “guidelines”) that prescribe treatments for whole classes of patients?
I don’t believe the same type of young people will apply. Few of my medical-school classmates wanted to become government employees. If they had, they would have skipped medical school, internship, residency, and fellowship − and instead taken the Civil Service exam, and be making good money at a 9-to-5 job, while I was still working 100 hours a week for next to nothing.
Are physicians reactionaries who insist on the status quo? Not at all. The study shows that only 4% feel that no change is needed. At the other extreme, 28% favor a public option. But an overwhelming 63% favor gradual change, with improvements meant to remedy specific problems. That sounds like a plan.
Whatever your notion of an ideal health-care system, you must admit that it can’t work without an adequate number of motivated, competent physicians. Politicians, ivory-tower dwellers, and worshippers of big government tend to forget that basic fact.
But cheer up. When your doctor from Outbackistan tries to explain bureaucratic “treatment guidelines” to your nurse who speaks mainly Wombosi, you won’t have to worry about your hospital bill. You won’t live long enough to run up a big one. Chalk up another “cost saving.”
Dr. Stolinsky writes on political and social issues. Contact: firstname.lastname@example.org.