# The looming physician shortage **URL:** \ **Category:** Great Debates\ **Created:** [May 31, 2017, 6:30pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786 "2017-05-31T18:30:25Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 31, 2017, 6:30pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/1 "2017-05-31T18:30:25Z")
> **[Blame Obamacare and Congress for the coming drought of doctors](https://www.washingtonexaminer.com/blame-obamacare-and-congress-for-the-coming-drought-of-doctors)** > > When you go to the Internet or phone book today, there are hundreds of physicians listed in most urban areas. But in the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming,... \*"A 2016 report from the Physicians Foundation found an alarming growth in burnout and dissatisfaction among practicing physicians — 47 percent of respondents in the survey indicated plans to “accelerate” their retirement and move into areas outside of clinical medicine. The most common reason for leaving medicine included regulatory burdens and electronic health records. Nearly 63 percent indicated that they have negative feelings about the future of healthcare and only half of all physicians would actually recommend a career in medicine to their children. Many of my colleagues feel they have no voice and have no way to impact healthcare policy — even in their own institution. … A 2016 report from the Physicians Foundation found an alarming growth in burnout and dissatisfaction among practicing physicians — 47 percent of respondents in the survey indicated plans to “accelerate” their retirement and move into areas outside of clinical medicine. The most common reason for leaving medicine included regulatory burdens and electronic health records. Nearly 63 percent indicated that they have negative feelings about the future of healthcare and only half of all physicians would actually recommend a career in medicine to their children. Many of my colleagues feel they have no voice and have no way to impact healthcare policy — even in their own institution."\* I agree with this. I know a lot of physicians - family and friends (and their friends). Almost none would recommend to any kid to become a physician today, and a lot are considering retiring early. The vaunted “single payer” possible system will only accelerate this phenomenon. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [May 31, 2017, 6:44pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/2 "2017-05-31T18:44:08Z")
Actually, single payer would likely fix the problem. Which do you suppose is a bigger burden: one insurance company breathing down your neck, or many insurance companies breathing down your neck? ---
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 31, 2017, 6:48pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/3 "2017-05-31T18:48:32Z")
> [@Ravenman](#): > > Actually, single payer would likely fix the problem. Which do you suppose is a bigger burden: one insurance company breathing down your neck, or many insurance companies breathing down your neck? If an insurance company imposes too much regulation on you as a physician, you can stop your contract with them (and I have seen physicians do that). If there is only one “payer”, and you object to them “breathing down your neck”, you’re SOL. And if you think the government will “breathe down their necks” less - I’ve got a bridge to sell you. ---
**Author:** ![SingleMalt](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/singlemalt/32/3961_2.png) [@SingleMalt](https://boards.straightdope.com/u/SingleMalt)\ **Post date:** [May 31, 2017, 6:49pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/4 "2017-05-31T18:49:46Z")
> [@Okrahoma](#): > > [http://www.washingtonexaminer.com/blame-obamacare-and-congress-for-the-coming-drought-of-doctors/article/2624432](http://www.washingtonexaminer.com/blame-obamacare-and-congress-for-the-coming-drought-of-doctors/article/2624432) > > … The most common reason for leaving medicine included regulatory burdens and electronic health records… > > The vaunted “single payer” possible system will only accelerate this phenomenon. This is one of the main things that single payer would definitely improve. No disparate rules and paperwork from dozens of insurance companies. No refiling of claims because some code number was incorrect. … And, ninja’d by Ravenman… ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [May 31, 2017, 7:06pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/5 "2017-05-31T19:06:54Z")
> [@Okrahoma](#): > > The vaunted “single payer” possible system will only accelerate this phenomenon. [This is from 2011, but…](http://content.healthaffairs.org/content/30/8/1443.full?keytype=ref&siteid=healthaff&ijkey=mQS3t4CreN%2F1Y) We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently. [From 2012:](http://www.commonwealthfund.org/publications/in-the-literature/2012/nov/survey-of-primary-care-doctors) •In the U.S.—the only country in the survey without universal health coverage—59 percent of physicians said their patients often have trouble paying for care. Far fewer physicians in Norway (4%), the U.K. (13%), Switzerland (16%), Germany (21%), and Australia (25%) reported affordability was a concern for their patients. •More than half (52%) of U.S. doctors said they or their staff spend too much time dealing with insurers’ restrictions on covered treatments or medications—by far the highest rate in the survey. •U.S. physicians were the most negative about their country’s health system, with only 15 percent saying the system needs only minor change. Y’know, it actually looks to me like those single-payer countries are better for the physicians, as well as their patients. ---
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 31, 2017, 7:21pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/6 "2017-05-31T19:21:30Z")
> [@Human\_Action](#): > > We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. Doctors in Canada earn about half, on the average, what their counterparts in the US earn. And that’s _after_ the higher costs that you cited. So the costs don’t really enter into the “doctor satisfaction” equation. > [@](#): > > •More than half (52%) of U.S. doctors said they or their staff spend too much time dealing with insurers’ restrictions on covered treatments or medications—by far the highest rate in the survey. Yes, when the government is the only “insurer”, doctors won’t spend as much time dealing with it. Because there won’t be a negotiation. There will be a diktat. You think that’s better? I don’t think so. > [@](#): > > Y’know, it actually looks to me like those single-payer countries are better for the physicians, as well as their patients. I’d like to see some stats on how many “single payer” countries’ doctors migrate to the US vs. how many US doctors migrate to the “single payer” countries. ---
**Author:** ![ganthet](https://avatars.discourse-cdn.com/v4/letter/g/9de0a6/32.png) [@ganthet](https://boards.straightdope.com/u/ganthet)\ **Post date:** [May 31, 2017, 7:28pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/7 "2017-05-31T19:28:11Z")
> [@Human\_Action](#): > > Y’know, it actually looks to me like those single-payer countries are better for the physicians, as well as their patients. In his (almost certain) ignorance, Trump actually spoke some truth when he complimented [Australia’s health care system](https://en.wikipedia.org/wiki/Health_care_in_Australia). They have a standard baseline of universal health care, but also a supplemental private health insurance system. Hospitals can be either private or government-run medical facilities. This would seem to not only provide a baseline of universally-accessible health care, but also address the criticisms of Canada’s system and the UK’s NHS concerning the lack of ability to seek medical care outside the government-run system in order to get treatment faster or for more elective procedures. ---
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 31, 2017, 7:32pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/8 "2017-05-31T19:32:42Z")
> [@Okrahoma](#): > > I’d like to see some stats on how many “single payer” countries’ doctors migrate to the US vs. how many US doctors migrate to the “single payer” countries. Here are some stats I found for Canada/US: > **[The Canadian contribution to the US physician workforce](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839794/)** > > A physician shortage has been declared in both Canada and the United States. We sought to examine the migration pattern of Canadian-trained physicians to the United States, the contribution of this migration to the Canadian physician shortage and... 19% of Canadian specialist physicians practice in the US. 8% of Canadian primary care physicians practice in the US. 408 graduates of US medical schools practice in Canada. ---
**Author:** ![Steve\_MB](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steve_mb/32/5339_2.png) [@Steve\_MB](https://boards.straightdope.com/u/Steve_MB)\ **Post date:** [May 31, 2017, 7:36pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/9 "2017-05-31T19:36:27Z")
> [@Okrahoma](#): > > Yes, when the government is the only “insurer”, doctors won’t spend as much time dealing with it. Because there won’t be a negotiation. There will be a diktat. You say DIK-tat (from the gummint); I say dik-TATE (from the insurance company). That’s the only difference; let’s call the whole thing off. ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [May 31, 2017, 7:38pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/10 "2017-05-31T19:38:27Z")
> [@Okrahoma](#): > > Doctors in Canada earn about half, on the average, what their counterparts in the US earn. And that’s _after_ the higher costs that you cited. So the costs don’t really enter into the “doctor satisfaction” equation. Sure they do, because an average is an average. There will be physicians on the lower curve of earning, that are getting crushed by the overhead and admin expenses of US health care. > [@](#): > > Yes, when the government is the only “insurer”, doctors won’t spend as much time dealing with it. Because there won’t be a negotiation. There will be a diktat. You think that’s better? I don’t think so. All I know is that, in a survey of physicians from 10 nations, the American doctors were the most negative about their country’s health care system. If doctors love negotiating with insurance companies so much (as opposed to actually practicing medicine, and giving their patients the care they need), how do you explain this? It’s not like American physicians are _more_ regulated than those other countries’, or use electronic health records more (in fact, per that same cite, the US is middle-of-the-pack in use of EMR). ---
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [May 31, 2017, 7:54pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/11 "2017-05-31T19:54:29Z")
> [@Okrahoma](#): > > Here are some stats I found for Canada/US: > > [The Canadian contribution to the US physician workforce - PMC](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839794/) > > 19% of Canadian specialist physicians practice in the US. > 8% of Canadian primary care physicians practice in the US. > > 408 graduates of US medical schools practice in Canada. So what? Saying that American doctors (and some Canadian doctors) are making a lot of money from the American health care system isn’t a point in favor of the system. A health care system shouldn’t be based on what produces the most money for doctors just as a legal system shouldn’t be based on what produces the most money for lawyers. ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [May 31, 2017, 7:55pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/12 "2017-05-31T19:55:16Z")
> [@Okrahoma](#): > > If an insurance company imposes too much regulation on you as a physician, you can stop your contract with them (and I have seen physicians do that). > > If there is only one “payer”, and you object to them “breathing down your neck”, you’re SOL. And if you think the government will “breathe down their necks” less - I’ve got a bridge to sell you. For many hospitals and doctors, Medicare is a substantial part of their business, so if you object to that payer (i.e., the federal government), you’re already SOL. At the [Ronald Reagan UCLA Medical Center](http://gis.oshpd.ca.gov/atlas/places/facility/106190796), for example, Medicare is about one-third of the business, and Medi-Cal is another substantial chunk. And in many parts of the country, most privately insured patients are covered by the same small group of insurers. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [May 31, 2017, 8:28pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/13 "2017-05-31T20:28:26Z")
American doctors sound over-regulated. Single-payer will fix some of that. ---
**Author:** ![Happy\_Fun\_Ball](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/happy_fun_ball/32/17664_2.png) [@Happy\_Fun\_Ball](https://boards.straightdope.com/u/Happy_Fun_Ball)\ **Post date:** [May 31, 2017, 8:30pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/14 "2017-05-31T20:30:10Z")
> [@](#): > > The looming physician shortage I got your solution right [here](http://www.businessinsider.com/ibms-watson-may-soon-be-the-best-doctor-in-the-world-2014-4). ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [May 31, 2017, 8:43pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/15 "2017-05-31T20:43:32Z")
> [@Okrahoma](#): > > I’d like to see some stats on how many “single payer” countries’ doctors migrate to the US vs. how many US doctors migrate to the “single payer” countries. My doctor in Prague (who is Czech) got his M.D. in the USA and had a practice in Virginia for about 20 years. He told me that he got tired of doing paperwork and wanted to practice medicine, so he closed shop and moved to Prague where he takes no insurance, just cash or card, and is very happy charging people $25 for a consultation. ---
**Author:** ![lisiate](https://avatars.discourse-cdn.com/v4/letter/l/f05b48/32.png) [@lisiate](https://boards.straightdope.com/u/lisiate)\ **Post date:** [May 31, 2017, 9:02pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/16 "2017-05-31T21:02:49Z")
> [@Happy\_Fun\_Ball](#): > > I got your solution right [here](http://www.businessinsider.com/ibms-watson-may-soon-be-the-best-doctor-in-the-world-2014-4). Yep Robodocs for the win! ---
**Author:** ![Dewey\_Finn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dewey_finn/32/4222_2.png) [@Dewey\_Finn](https://boards.straightdope.com/u/Dewey_Finn)\ **Post date:** [May 31, 2017, 9:28pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/17 "2017-05-31T21:28:35Z")
> [@Desert\_Nomad](#): > > > [@Okrahoma](#): > > > > I’d like to see some stats on how many “single payer” countries’ doctors migrate to the US vs. how many US doctors migrate to the “single payer” countries. > > My doctor in Prague (who is Czech) got his M.D. in the USA and had a practice in Virginia for about 20 years. He told me that he got tired of doing paperwork and wanted to practice medicine, so he closed shop and moved to Prague where he takes no insurance, just cash or card, and is very happy charging people $25 for a consultation. There are a few doctors in the US doing that sort of thing; not accepting insurance at all in favor of only patients who can afford to pay directly for treatment. Some limit the number of patients to a relatively small amount (perhaps a few hundred or a thousand) and require an annual fee in addition to charges based on the number of visits. ---
**Author:** ![Ramira](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ramira/32/344_2.png) [@Ramira](https://boards.straightdope.com/u/Ramira)\ **Post date:** [May 31, 2017, 9:35pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/18 "2017-05-31T21:35:13Z")
> [@Okrahoma](#): > > Yes, when the government is the only “insurer”, doctors won’t spend as much time dealing with it. Because there won’t be a negotiation. There will be a diktat. You think that’s better? I don’t think so. > > . So you americans can continue to out perform the rest of the developed countries in your overall national health indicators while enjoying the cost effectiveness of your system… ---
**Author:** ![FlikTheBlue](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fliktheblue/32/10972_2.png) [@FlikTheBlue](https://boards.straightdope.com/u/FlikTheBlue)\ **Post date:** [May 31, 2017, 10:08pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/19 "2017-05-31T22:08:53Z")
I can’t speak for all my colleagues, but as a physician I would personally prefer a universal health care system done correctly\* to what we have right now. If we had single payer with simple rules, that would mean I could probably see about twice as many patients as I do currently. At least half my workday consists of filling out forms and dealing with administrative things that I wouldn’t have to deal with under a single payer system. - Yes, I’m implying that single payer is the best way to implement universal healthcare. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 31, 2017, 10:11pm UTC](https://boards.straightdope.com/t/the-looming-physician-shortage/787786/20 "2017-05-31T22:11:10Z")
> [@FlikTheBlue](#): > > I can’t speak for all my colleagues, but as a physician I would personally prefer a universal health care system done correctly\* to what we have right now. If we had single payer with simple rules, that would mean I could probably see about twice as many patients as I do currently. At least half my workday consists of filling out forms and dealing with administrative things that I wouldn’t have to deal with under a single payer system. > > - Yes, I’m implying that single payer is the best way to implement universal healthcare. As a physician I agree. I also hope we’d get to spend more time with patients, rather than just see more of them. I love doing patient care, but to do it right, I need to take time with them. [Next page](https://boards.straightdope.com/t/the-looming-physician-shortage/787786.md?page=2)