Author Topic: No, There Won’t Be a Doctor Shortage By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL  (Read 755 times)

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Offline mystery-ak

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http://www.nytimes.com/2013/12/05/opinion/no-there-wont-be-a-doctor-shortage.html?ref=opinion&_r=1&&pagewanted=print

December 4, 2013
No, There Won’t Be a Doctor Shortage
By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL

IN just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.

The road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks.

Shortage forecasters point to two major factors. One is an aging population. The proportion of Americans who are 65 and older will increase to 19 percent in 2030 from 12.9 percent today, according to federal projections. Second, Obamacare will insure 30 million more Americans by the end of the decade, dramatically increasing demand for physicians. Extrapolating forward from today’s 2.4 physicians per 1,000 Americans would mean we will need at least 90,000 more physicians by 2020, or so the reasoning goes.

Regardless of your political views, there are good reasons to be skeptical of these predictions. Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey. Massachusetts’s experience may differ from other areas, particularly rural regions, but the results of reform there suggest shortage fears are exaggerated.

The population is indeed aging fast, but the methods of treating illness in old age are also changing quickly. Today, more patients can be cared for in subacute settings rather than in hospitals. And new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness.

Innovations, such as sensors that enable remote monitoring of disease and more timely interventions, can help pre-empt the need for inpatient treatment. Drugs and devices can also obviate the need for more costly treatments. Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians. An average patient stay in the hospital is about two days or less following a stent but about seven days following a coronary bypass operation. Research on radiation treatments for breast cancer suggests that 15 treatments can be just as effective as the traditional 30 treatments. Likewise, one larger dose of radiation can be as good at relieving pain from bone metastases as five to 10 separate, smaller treatments. There’s every reason to expect the pace of these timesaving medical innovations to continue.

Other medical personnel can also expand the reach of physicians to care for a larger population. Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future. The rise of nonphysician providers will enable more team care. Skilled health aides will monitor patients at home and alert a doctor if certain medical parameters decline. Nurses will provide wound care to diabetic patients, adjust medications like blood thinners and provide the initial management of chemotherapy side effects for cancer patients. Pharmacists will provide more counseling and urgent care. Physicians will remain essential to the proper diagnosis and treatment of disease, but will be backed up by teams who will help manage the more routine features of chronic illness.

The opportunity exists to deliver more services and care with fewer physicians, but it’s not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care.

That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.

Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other health care workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better.

Scott Gottlieb, an internist and fellow at the American Enterprise Institute, was a senior official at the Centers for Medicare and Medicaid Services during the George W. Bush administration. Ezekiel J. Emanuel, a former health policy adviser to the Obama administration, is an oncologist, vice provost at the University of Pennsylvania and contributing opinion writer.

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Offline Atomic Cow

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The New York Slimes is the Völkischer Beobachter of the Obama regime.  Or perhaps Der Stürmer would be a better comparison.
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Offline olde north church

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Isn't Scott Gottlieb the guy who has been all over Fox News lately with the doom and gloom predictions about how bad the doctor situation is going to be or is there another Gottlieb?
Why?  Well, because I'm a bastard, that's why.

Online mountaineer

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Quote
Nurse practitioners, health aides, pharmacists, dietitians, psychologists and others already care for patients in numerous ways, and their roles should expand in the future. The rise of nonphysician providers will enable more team care.
Under O'care, it still might be worth it to become a nurse, aide, etc.  Not so much for physicians.
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Online Bigun

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So now seeing a nurse practitioner is the same as seeing a doctor??

Isn't that somewhat akin to asking a stewardess to fly the 747 that is her workplace?

Offline Rapunzel

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So now seeing a nurse practitioner is the same as seeing a doctor??

Isn't that somewhat akin to asking a stewardess to fly the 747 that is her workplace?

Yep............
“The time is now near at hand which must probably determine, whether Americans are to be, Freemen, or Slaves.” G Washington July 2, 1776

Offline flowers

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So now seeing a nurse practitioner is the same as seeing a doctor??


. The small part I read of obamacare it lets nurse practitioners do the work of doctors. it also lets them come into your home and inspect it


Offline Cincinnatus

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MDs? ARNPs? Who needs 'em? Soon under ObamaCare for our ills Obama & Co. will take a page from Mao's and Fidel's books and we will be treated by these guys (and gals).

Quote
Barefoot doctors (Chinese: 赤脚医生; pinyin: chìjiǎo yīshēng) are farmers who received minimal basic medical and paramedical training and worked in rural villages in the People's Republic of China. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle. They promoted basic hygiene, preventive health care, and family planning and treated common illnesses. The name comes from southern farmers, who would often work barefoot in the rice paddies.

In the 1930s, the Rural Reconstruction Movement had pioneered village health workers trained in basic health as part of a coordinated system, and there had been provincial experiments after 1949, but after Mao Zedong's healthcare speech in 1965 the concept was developed and institutionalized. In his speech, Mao Zedong criticized the urban bias of the medical system of the time, and called for a system with greater focus on the well being of the rural population.[1] China's health policy changed quickly after this speech and in 1968, the barefoot doctors program became integrated into national policy.[1] These programs were called "rural cooperative medical systems" (RCMS) and strove to include community participation with the rural provision of health services.[2] Barefoot doctors became a part of the Cultural Revolution, which also radically diminished the influence of the Weishengbu, China's health ministry, which was dominated by Western-trained doctors.


http://en.wikipedia.org/wiki/Barefoot_doctor

It will be great and everyone will be taken care of.
« Last Edit: December 05, 2013, 03:44:32 PM by Cincinnatus »
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Offline sinkspur

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So now seeing a nurse practitioner is the same as seeing a doctor??

Isn't that somewhat akin to asking a stewardess to fly the 747 that is her workplace?

I haven't seen a physician in three years.  Nurse practitioners can even do wellness exams and are easier to get in to see.

I'd just has soon have a doc on the other end of an email.  And why can't pharmacists (who administer shots) do blood tests? 
From  "A Shining City on a Hill"

To "A global laughingstock"

Offline sinkspur

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Yep............

And seeing as how a 777 can fly and land itself, pilots are really only needed to take off and when something unforeseen happens.
From  "A Shining City on a Hill"

To "A global laughingstock"

Offline Cincinnatus

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How about that?

And seeing as how a 777 can fly and land itself, pilots are really only needed to take off and when something unforeseen happens.

I think we have found our first barefoot doctor.
We shall never be abandoned by Heaven while we act worthy of its aid ~~ Samuel Adams

Offline andy58-in-nh

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So now seeing a nurse practitioner is the same as seeing a doctor??

It's rationing, by other means. It's like paying for concert tickets to see the Rolling Stones, but getting a decent cover band instead. They know all the chords and some of the licks, but that ain't Mick Jagger up there. Mick is getting private clinic treatment in the Azores for his chronic hip inflammation.
Liberalism isn't really about making the world a better place. It's about reassuring the elites that they are good people for wanting to rule over it.

Offline Lipstick on a Hillary

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I haven't seen a physician in three years.  Nurse practitioners can even do wellness exams and are easier to get in to see.

I'd just has soon have a doc on the other end of an email.  And why can't pharmacists (who administer shots) do blood tests?

What in hell are you talking about?  What do you mean "do blood tests?"  Do you mean prescribing the specific blood test, drawing the blood from the patient, or performing the actual testing on the blood sample? 

Online Bigun

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What in hell are you talking about?  What do you mean "do blood tests?"  Do you mean prescribing the specific blood test, drawing the blood from the patient, or performing the actual testing on the blood sample?

AS USUAL he doesn't have the first clue as to what he is talking about!

Offline Rapunzel

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AS USUAL he doesn't have the first clue as to what he is talking about!

Nope.. two totally different professions.
“The time is now near at hand which must probably determine, whether Americans are to be, Freemen, or Slaves.” G Washington July 2, 1776

Offline Oceander

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Ezekiel J. Emanuel is brother to Rahm Emanuel, and the creator of a "health care" system known as "complete lives."  Under Zeke's "complete lives" paradigm, most health care resources are devoted to those who are older than 12 and younger than 59; those who are 12 or younger, or 59 and older, are intentionally deprived of health care resources and, accordingly, are intended to have increased rates of mortality and, generally speaking, less pleasant lives.  Most egregious is the intent of depriving young children of adequate health care resources; doing so will necessarily damage the lives of those kids who manage to survive past 12.  Of course, since the complete lives system requires political control of the health care system, the degree to which children are deprived of health care resources will be politically motivated.  In other words, under Zeke Emanuel's paradigm, the lives of individuals can be controlled through the simple expedient of determining - based on political considerations - whether they will receive adequate health care or not, and almost certainly, who among the children will be deprived and who will not.

It shouldn't take too much reading up on the history of the NSDAP and their public health care systems to realize that Zeke Emanuel is nothing more, and nothing less, than a fascist.  The NSDAP?  They were better known as the Nazis.

Offline Rapunzel

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This speaks to the idiots behind Obamacare (to me)


« Last Edit: December 05, 2013, 10:12:17 PM by Rapunzel »
“The time is now near at hand which must probably determine, whether Americans are to be, Freemen, or Slaves.” G Washington July 2, 1776


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