First off, to address the title: I call it that to give the man credit for making what I consider an improvement to the system. Doesn’t go near far enough IMHO, but it is at least a start if not a great one.
So I need to see an ENT about my ear. ALL of the local ones require a referral from another doctor. This is not a requirement of my insurance, but a choice the ENTs have made because they are overwhelmed with patients, and want to make sure every new patient really needs a specialist.
After getting a refferal, and spending all morning on the phone, I was able to find one with only a 3 month backlog. One group practice was booked 7 months in advance.
I mentioned this to a friend, and he reflexively opined “You think it is bad now, just wait for Obamacare!”
He apparently thinks that more people having access to medical care will result in an exacerbated shortage of doctors. I agree that this may happen in the short term.
I think the local shortage of specialists is being driven by a high percentage of the local population that has no insurance or medicaid. I think if more people had the means to pay for medical care, that specialists would be less likely to go seeking greener pastures.
Of course neither of us are employed in the medical field. What say the wise dopers?
In this situation, it sounds like Obamacare will exacerbate the shortage of ENTs. If Obamacare works, more people will have primary doctors who can refer them to ENT specialists, thus increasing demand.
If, as you say, at the current level of demand, clinics are booked three and seven months in advance, it would seem clear (all other things being equal) that increasing demand will mean more calls on the limited time of the specialists.
Then either prices will be allowed to rise, and this will attract specialists to your area (assuming the wait times are unusual for the country as a whole) and then the increased supply of ENTs will offset the increased demand, albeit at a higher price. Or else prices will not be allowed to increase, in which case wait times will be that much worse.
I think it will make the wait times worse in the short run, but I disagree with Shodan about the reason for the short supply.
I strongly doubt the reason ENTs are in short supply is because ENTs are not getting paid well (I imagine, like most doctors, they are paid quite well). I believe the shortage in supply is more due to the limiting factors of medical schools not having enough slots and the state medical board not accepting foreign medical degrees as readily.
I have heard (no cite, apologies) that the AMA is just fine with this situation, as it drives up doctor salary, which on the one hand is a terrible thing to think about the AMA but on the other hand I can easily see other industry groups doing that so why not this one?
I didn’t actually say anything about the reason for the short supply of ENTs. Just that a rise in prices tends to attract supply from other areas where the same resource is lower.
You may well be correct that the AMA is limiting the number of doctors to keep their salaries up, but I doubt Obamacare is going to address that issue either.
My apologies, I didn’t mean to put words in your mouth. My presumption is that there is a shortage of specialists, including ENTs, everywhere, and so rising prices will not attract significant numbers of ENTs because there are not ENTs to attract in the first place.
I have seen some references to it also increasing the number of med school graduates (both domestic and international) but can’t find a good cite for that right now.
Didn’t the Medicare Payment Advisory Commission rule that specialists get their fees cut 6% per year over the next two or three years with a freeze on fees over the next decade? Private insurers will surely follow suit and reduce reimbursements as well. That can only result in a reduction in specialists over time. Or was that changed?
Many may decide to retire early. Newly minted physicians may decide it’s not worth the extra time to specialize for the return on their investment. These two things alone could cause a shortage in short order.
“I won’t make enough money, so I’ll retire and make even less” doesn’t sound like a cogent reason to retire.
My mother(who is not a doctor), retired because of looming changes to her company pension. That made sense: staying meant ultimately she would get less money after she retired. She gave up about 2 years of income for that, but in the long run, she would have lost more.
My doctor retired because of changes as well, but not due to income. He told me that Canada’s medical system was becoming more like America’s and he didn’t like the changes. He didn’t elaborate. He is American born and practised in Canada for 40 some years.
The underlying causes of your local ENT shortage (and our physician shortage generally) have nothing to do with Obamacare. The problem dates from the 1980s, when the AMA decided it would all but stop accrediting new medical schools because it foresaw a physician glut (that was never even close to actually occurring).
Sure it does. Many physicians are well past retirement age but keep working because they love what they do. When the job becomes a burden due to increased paperwork and decreased profit many will choose to go ahead and retire. Here is one study from Deloitte that states the following:
That may not all be attributable to Obamacare but any decrease in income would only lower the total number of physicians willing to stay in their jobs and potential physicians from going into the profession to start with.
Not necessarily leading to a drop in total physicians being trained, mind you. If the buffer of people who want to be physicians but who are blocked by some other structural problem (for example, as RNATB points out, the deliberate slowdown of medical school accreditation) is sufficiently large then having a few outliers decide that 6% of ~$300kyr is enough to make them change their entire life is not going to appreciably drop the number of physicians.
That’s a valid point. I don’t know if current med schools have the ability to expand class size or if new med schools would need to open in order to increase the total number of graduates. Nonetheless, if salaries of specialists start to approach those of PCPs then, inevitably, people will decide to take the path of least resistance. I personally know a number of people who have decided not to go into specialties that take longer times because they just don’t want to spend another X number of years being poor. I can only assume that people will be less likely to go the extra mile if the money isn’t there either.
Yeah, but it’s a question of how much less money. As of 2012, the difference between a ordinary physician and a specialist is anywhere from 30k to 300k±-is making that 25k to 250k instead (using the numbers quoted upthread) really likely to make that many people change their life plans?
As with many other threads about the economics of decision-making, I’m pretty skeptical of even a 10-15% change in income causing a lot of sea changes in decision-making for people who are already significantly above (as in 2-5x the average) the norm in both income and time invested in gaining that income.
Right now, they’re attempting both. The problem with increasing class sizes is that medical schools tend to be sized to fit the teaching hospitals and other institutions they are attached to. The problem with opening new schools is of course that they take ages to build and have to be created by state legislatures even before that and so on.
Beyond that, neither method has any impact within 10 years, since that’s how long it takes to turn out a physician.
How much of that money is going toward increased malpractice? Specialists usually provide more high-risk procedures and the increased cost of malpractice cuts into their bottom line. Solo practitioners are hit especially hard by these costs. Salaries for some specialties may look great on paper but, after malpractice and student loans, they may not be bringing enough home to make the extra effort worthwhile.
Great point. I assume we can increase the total number of physicians but it will take a good deal of time. I also wonder if admitting more people will result in an increase in PCPs but not necessarily specialists (i.e. are we letting less qualified people into these programs or are there plenty of qualified people not able to get in currently?)
nods Still, you’re talking about a 10-15% change. That’s not really earth-shattering–it wouldn’t be for me and I make about a third on paper compared to some of these salaries. Are physicians really so likely to be about the money rather than the job compared to other professions that there’s that much elasticity, or am I unusually inelastic?