USA's 1 million-doctor shortage upon us...

[jaeger19]

i don't argue that the market shouldn't have a role, but i really think that we need to look at health care systems in other first world countries that are working more efficiently. for example, Canadians wouldn't trade us health care systems.

That's a false argument.

 

[jaeger19]

i don't really agree. maybe a Canadian / French sort of healthcare system would be better.

Or worse.

 

[Ntharotep]

Here's the real reason:
$1 million mistake: Becoming a doctor - CBS News
That little fact always seems to be missing from the conversations. Educations are getting like buying a house.

It isn't just education for doctors either. From what I've heard, since what I jokingly call the "malpractice bubble" of late 90s early 00s, malpractice insurance has also become quite the racket in and of itself. Insurance costs for doctors have gone crazy.

i don't really agree. maybe a Canadian / French sort of healthcare system would be better.

I've heard good things about Canada's healthcare but I am not sure if it doesn't have the same setback as in the UK (taxes from hell).
If you are taxed to death, then having "free healthcare" doesn't help you out much.
But I will admit, I haven't compared Canada's taxes to the U.S. and having all of this stuff "taken care of" in the background without paying upfront costs is appealing.

 

[Helix]

Yeah, for baby boomers like myself, our family doctors had nowhere near the hurdles that they have today. Health care was state of the art for the times, appointments were easy and the nurses dressed like nurses. The bill for my birth was $240.00.

It's the cost of health care that's driving us to the moon with the ACA and all of the crazy insurance rates. We've created our own Frankenstein with the free market and now it's destroying the lab that it was built in.

yeah, it's a real mess. there are a lot of factors, but basically it boils down to the fact that health care is an essential service with inelastic demand, and one in which geographical immediacy is a big factor. that's a recipe for the market to function pretty inefficiently.

my guess is that eventually, we'll have some form of Medicare for all. as for the ACA, it was a BS half measure that isn't likely to be a real solution. at best, it's a step toward single payer.

 

[Helix]

that implies america has a healthcare system similar to 1st world nations already, when in fact america has a 3rd world healthcare system, america should look towards second world countries like cuba



Cuba?s biggest export is teachers, doctors ? not revolution

meh, i wouldn't call it third world. i'd call it haphazardly pieced together and inefficient. depending on where you work, it might be a very good system for you personally.

however,



i mean, i suppose you could put your fingers in your ears and scream la la la i can't see you, but the fact of the matter is that other countries deliver the same or better care at a fraction of the price. not to mention that saddling employers with having to be health care providers is a pretty big burden on them.

 

[Helix]

Its one thing. the other thing is the way healthcare is being delivered. There is less independence of practice. More pressure to be "productive".. less time with patients, etc.

Heck.... being a physician is going the way that teaching has gotten.

Teachers used to be respected members of the community. Highly educated people that were thought to provide a valuable service. Now? Much maligned as overpaid, lazy, "can't do" people

Medical providers were respected members of the community. highly educated people that were thought to provide a valuable service. Now? Much Maligned as "greedy, overpaid, worthless.

(until you need them).

i don't think that doctors are greedy monsters. i'm arguing that we increase the supply of them by not making kids have to go broke in order to become one.

 

[Helix]

That's a false argument.

i don't agree. no way would the average Canadian swap us systems and risk crushing medical debt just because he or she gets sick or loses a job. there have been a couple threads in which this specific question was asked, and i can't recall many of our posters from single payer countries chomping at the bit to pay for health care like we do.

of course, the topic of this thread is doctor shortages, so i suppose i'm dragging it off into a tangent. suffice it to say that i think the financial barrier should be seriously reduced, if not removed entirely.

 

[jaeger19]

i don't think that doctors are greedy monsters. i'm arguing that we increase the supply of them by not making kids have to go broke in order to become one.

Oh I know Helix. It was not a stab on you... I am just pointing out that its more than just the cost of education. There are other social and economic factors that are pushing qualified people away from being physicians/medical providers.

 

[jaeger19]

i don't agree. no way would the average Canadian swap us systems and risk crushing medical debt just because he or she gets sick or loses a job. there have been a couple threads in which this specific question was asked, and i can't recall many of our posters from single payer countries chomping at the bit to pay for health care like we do.

of course, the topic of this thread is doctor shortages, so i suppose i'm dragging it off into a tangent. suffice it to say that i think the financial barrier should be seriously reduced, if not removed entirely.

And I point out.. of course not because most people aren't sick. So stating.. "well they wouldn't give up their system for the US".. is a false argument. They have no way of comparing the two systems unless you are sick in each of them.. or understand what the system really is.

Now.. you say.. they wouldn't trade "crushing debt because they get sick"...

What if they had cancer would they trade 5 more years of life in the US versus not surviving in the UK? Or other country?

 

[Helix]

And I point out.. of course not because most people aren't sick. So stating.. "well they wouldn't give up their system for the US".. is a false argument. They have no way of comparing the two systems unless you are sick in each of them.. or understand what the system really is.

i don't think that they would. if there's any any Canadian here who would like to claim that they would trade systems, then this thread becomes story time with Helix.

Now.. you say.. they wouldn't trade "crushing debt because they get sick"...

What if they had cancer would they trade 5 more years of life in the US versus not surviving in the UK? Or other country?

the US does slightly better with some types of cancer at a much higher price. the rest is mostly a wash.

U.S. Health Care from a Global Perspective - The Commonwealth Fund

 

[Helix]

Oh I know Helix. It was not a stab on you... I am just pointing out that its more than just the cost of education. There are other social and economic factors that are pushing qualified people away from being physicians/medical providers.

i didn't take it as a stab, so no worries. as with most problems, it's a multi-faceted one. however, incurring massive amounts of debt is a real deterrent.

 

[Thrilla]

Yeah, for baby boomers like myself, our family doctors had nowhere near the hurdles that they have today. Health care was state of the art for the times, appointments were easy and the nurses dressed like nurses. The bill for my birth was $240.00.

It's the cost of health care that's driving us to the moon with the ACA and all of the crazy insurance rates. We've created our own Frankenstein with the free market and now it's destroying the lab that it was built in.

i love it when people bring the free market into healthcare issues.... healthcare is one of the most unfree markets in existence, and yet free markets are to blame for the position that market is in. < derp derp>

I'm not saying free markets are the answer, but for god sake, if you can't even identify the problem accurately, you'll never find a solution.

 

[Hawkeye10]

i didn't take it as a stab, so no worries. as with most problems, it's a multi-faceted one. however, incurring massive amounts of debt is a real deterrent.

It is a combination of that and listening to too many people who have gone before you to medical school say stuff like:

"I wouldn't do it again, and it has nothing to do with the money. I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients. Working up patients in the ER these days involves shotguning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they don't need them, and being aware of the wastefulness of it all really sucks the love out of what you do. I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade."

Why Doctors Are Sick of Their Profession - WSJ

Putting in 7-9 years for training and accumulating a few hundred thousand dollars in debt (which cant be taken away in bankruptcy court) in the hopes that you will enjoy it when so many current doctors dont is a risk that many smart people are not willing to take. Getting stuck in a profession one hates, with a lot of debt to boot, is a level of hell.

 

[Hawkeye10]

Its one thing. the other thing is the way healthcare is being delivered. There is less independence of practice. More pressure to be "productive".. less time with patients, etc.

Heck.... being a physician is going the way that teaching has gotten.

Teachers used to be respected members of the community. Highly educated people that were thought to provide a valuable service. Now? Much maligned as overpaid, lazy, "can't do" people

Medical providers were respected members of the community. highly educated people that were thought to provide a valuable service. Now? Much Maligned as "greedy, overpaid, worthless.

(until you need them).

Can you imagine putting 20 years into this profession and then everyday having to listen to hicks who are sure that they know more than you about what pills and tests they need because of big pharma commercials on TV and what they saw on the internet? Then you get to constantly argue with the insurance companies too, and doctors always had to argue with the nurses...that is one hell of a way to make a living. If I am going to be a cog in a system I want to be an appreciated cog in the system, and I dont think it is just me who feels this way. It has been one steady long deep fall from the days of Marcus Welby MD, if I was a young buck right now I would not want to even contemplate what doctoring will be like by the time I hit retirement age. Maybe I do something else instead.

 

[jet57]

i love it when people bring the free market into healthcare issues.... healthcare is one of the most unfree markets in existence, and yet free markets are to blame for the position that market is in. < derp derp>

I'm not saying free markets are the answer, but for god sake, if you can't even identify the problem accurately, you'll never find a solution.

Health care is FIXED by the free market, and as long as it stays fixed it's vulnerable to takeover.

 

[Thrilla]

Health care is FIXED by the free market, and as long as it stays fixed it's vulnerable to takeover.

what?

 

[RetiredUSN]

Go to a Veterans hospital without a interpreter and tell me we are not short of American doctors. My VA doctor has to have a English speaking nurse by his side with patients.

 

[Hawkeye10]

Go to a Veterans hospital without a interpreter and tell me we are not short of American doctors. My VA doctor has to have a English speaking nurse by his side with patients.

That is the biggest reason why the VA system cant be fixed, there is a shortage of labor and the VA has pretty much the worse reputation of any doctor employer, and not just because of the low pay which would be easy to fix if Washington wanted to throw money at the problem. Indian Affairs is worse I think.

THis is why increasingly it looks like we are going to have to dissolve the system.

 

[dimensionallava]

meh, i wouldn't call it third world. i'd call it haphazardly pieced together and inefficient. depending on where you work, it might be a very good system for you personally.

however,

View attachment 67199853

i mean, i suppose you could put your fingers in your ears and scream la la la i can't see you, but the fact of the matter is that other countries deliver the same or better care at a fraction of the price. not to mention that saddling employers with having to be health care providers is a pretty big burden on them.

the usa has a lower life expantacy than costa rica and lebanon thats not exactly a good defense of your argument. Now technically the WHO rates america's healthcare system number #30 in the world (below such countries morroco and cyprus) but it doesn't take into account income inequality, meaning if you exclude the wealthiest people in the country, americas is much further down the list, over 50% of americas healthcare expenditures go to the top 5% of the population, because theyre the only ones who can afford it.

Fox commentator admits America has Third World health care

 

[Helix]

the usa has a lower life expantacy than costa rica and lebanon thats not exactly a good defense of your argument. Now technically the WHO rates america's healthcare system number #30 in the world (below such countries morroco and cyprus) but it doesn't take into account income inequality, meaning if you exclude the wealthiest people in the country, americas is much further down the list, over 50% of americas healthcare expenditures go to the top 5% of the population, because theyre the only ones who can afford it.

Fox commentator admits America has Third World health care

if it sounds too partisan to be true, it probably is. however, we'd be better off with a single payer system.

 

[jaeger19]

i don't think that they would. if there's any any Canadian here who would like to claim that they would trade systems, then this thread becomes story time with Helix.



the US does slightly better with some types of cancer at a much higher price. the rest is mostly a wash.

U.S. Health Care from a Global Perspective - The Commonwealth Fund

Well. I know folks that have. I have treated Canadians that have crossed the border to get faster treatment and better treatment in the States. Years ago.. it was fairly common.

Yes.. the US does better.. significantly better with many types of cancer. The rest is not mostly a wash when you consider our demographics. the typical US patient has more comorbidities than the overage European or Asian in a developed country. The reality is that we do better with those patients as well. (except for preventative. In that? We suck. However, the irony in that is that the insurances that are the worst for preventative care? Medicaid, VA and Medicare is in there (medicare is better than some private insurance about midway).

Now.. on to the "but they wouldn't change their system for ours"...

Well.. like I said.. that's true for a variety of reasons.

Many of them would not trade many of the systems that they value for American ones... for example the UK would probably not trade their system of gun restriction and regulation for ours.

Should we then say.. gee,,, lets go to the UK system?

The point being that other countries value things differently than the US.. and you may find that going to their system.. particularly healthcare.. might not be as great as you think it will be... despite the fact that THEY like their system.

 

[jaeger19]

i didn't take it as a stab, so no worries. as with most problems, it's a multi-faceted one. however, incurring massive amounts of debt is a real deterrent.

Cool.

Yes its a deterrent. but here is another point. That cost of education is reflected in what the doctor charges. The cost of medical care reflects the cost of education since that's how its recouped.

Now think about that for a minute. Now in other countries.. its touted about how "cheaper" their healthcare is. Well.. one of the reason it APPEARS cheaper is that the cost of education is NOT reflected in the cost of healthcare... its reflected in the cost of education since they educate their physicians.

So the cost to the public is not really cheaper.. its just reflected in a different column.

There are many costs that are shifted in socialized countries that shift the costs out of healthcare into other categories.. like retirement, or malpractice. And that's what accounts for some of the "difference" in cost between say France or Canada and the US. In part its simply a cost shift..and not really a savings.

 

[jaeger19]

Can you imagine putting 20 years into this profession and then everyday having to listen to hicks who are sure that they know more than you about what pills and tests they need because of big pharma commercials on TV and what they saw on the internet? Then you get to constantly argue with the insurance companies too, and doctors always had to argue with the nurses...that is one hell of a way to make a living. If I am going to be a cog in a system I want to be an appreciated cog in the system, and I dont think it is just me who feels this way. It has been one steady long deep fall from the days of Marcus Welby MD, if I was a young buck right now I would not want to even contemplate what doctoring will be like by the time I hit retirement age. Maybe I do something else instead.

I can listen to the patients tell me they know more. Heck.. I like that they are less passive now and are more active in their care. A world better than "whatever you say Doc"... and then getting pissed because things don't work out as they thought because they took no responsibility for their own care.

What really gets to me is 1. Insurance people telling me THEY know more about healthcare than me. and who is the worst? VA, Medicaid, and eventually Medicare (some private insurances are worse then Medicare) ..

After arguing to get a procedure approved for 30 minutes with an insurance muckity.. muck.... I asked..."tell me exactly how they need to be treated.. how do you want the procedure done"...

They gal said "oh I can't tell you that".. I said.. "well why not?"... She said "well I am not a doctor.. I am not qualified to do such"... I said "well then how in the hell are you qualified to make the decision whether this patient that you have never laid eyes on qualifies for this procedure"?????

2. I hate the attitude that because I am a medical provider.. that I have it easy and am rich and greedy. God that pisses me off. Try being on call and having to be tethered to a beeper/cell phone. See how that feels. Try having the pressure of someones life in your hands. Besides all the years of training.. when you were not making a dime, or hardly a dime.. now you are working hours on end. One of my colleague's realized what it was like one day (He's an ortho). He was planning to go to the zoo with his son.. when his cell phone went off. Without even asking.. his son got up and left and started doing something else. He had been conditioned like Pavlov's dogs.. that when Dad's sell phone goes off.. plans for the day are done. Try providing care and then never getting paid. Try working 20 years and seeing your reimbursement per patient GO DOWN.. while your costs go up.

Then I get to hear how greedy healthcare providers are and how we make too much money.

 

[Gimmesometruth]

2. I hate the attitude that because I am a medical provider.. that I have it easy and am rich and greedy. God that pisses me off. Try being on call and having to be tethered to a beeper/cell phone. See how that feels. Try having the pressure of someones life in your hands. Besides all the years of training.. when you were not making a dime, or hardly a dime.. now you are working hours on end. One of my colleague's realized what it was like one day (He's an ortho). He was planning to go to the zoo with his son.. when his cell phone went off. Without even asking.. his son got up and left and started doing something else. He had been conditioned like Pavlov's dogs.. that when Dad's sell phone goes off.. plans for the day are done. Try providing care and then never getting paid. Try working 20 years and seeing your reimbursement per patient GO DOWN.. while your costs go up.

Then I get to hear how greedy healthcare providers are and how we make too much money.

Aren't there laws against masquerading as a doctor?

 

[jaeger19]

the usa has a lower life expantacy than costa rica and lebanon thats not exactly a good defense of your argument. Now technically the WHO rates america's healthcare system number #30 in the world (below such countries morroco and cyprus) but it doesn't take into account income inequality, meaning if you exclude the wealthiest people in the country, americas is much further down the list, over 50% of americas healthcare expenditures go to the top 5% of the population, because theyre the only ones who can afford it.

Fox commentator admits America has Third World health care

Well, I think that speaks to the idiots that Fox has. Because its complete BS.

I welcome you to go to a third world country and see third world healthcare. Been there and done that. Why do you think we send US doctors and other medical providers to third world countries and do missions there? It ain't because its the same in the US.

The truth is that when it comes to care. the united states is among the best in the world. We are almost always in the top 10 and often in the top 5 countries in the world when it comes to quality care, effective care.. appropriate diagnosis etc.

The only reason that the US scores lower is because of categories like "equity of care".. and that's not because care is poor.. but because care is different between having insurance and not having insurance. So a country that has terrible quality of care.. but since everyone receives that same care.. they will score higher than the US.

We score lower in coordinated care.. which is not surprising since a single government system is going to be coordinated more than the US.

However.. its also why we tend to score higher on timeliness of care as well (though that's dragged down a bit because of the uninsured).

We also score lower because of preventative care... which that one? We suck. Of course the insurances that are the worst for preventative care? VA and Medicaid. Two government systems that are most like what a single universal healthcare system would be.

All you folks that things single payer would be better? Are living in fantasy land.