Too many doctors in US or not enough? What's the real story?

Factual Questions
1

For quite few years I’ve read occasional articles in popular news magazines how US medical schools are graduating too many med students for the population, and in addition to that you’ve got graduates of foreign medical schools coming onboard as well, that will lead to an overall “glut” of doctors.

And yet everywhere you look there are often substantive waits to get to see doctors on a non-emergency basis, and sometimes absurd waits to see a specialist.

What’s the real scoop? Does the US have too many doctors or not enough?

2

This is one of those situations where Google is NOT your friend. You will find contradictory answers depending on how you want to ask the question.

According to one set of statistics, the U.S. is below the median of 30 industrialized countries in the number of physicians per capita, with 2.8 physicians per thousand. But that statistic doesn’t make any distinction between public health physicians, physicians in private practice, primary care providers, physicians who teach, etc.

According to another set of statistics, the number of primary care physicians (gneral practitioners, family practitioners and internists) in the U.S. is only about 1.8 per thousand, with the rest being specialists.

However, many women prefer to use their gynecologist as their primary care physician, even though they’re classified as specialists. So that pushes the number back up.

Then you have the problem of physician distribution. I didn’t run statistics on this, but let’s say in general it’s easier to find a doctor in suburban New York City than it is in rural Mississippi or North Dakota.

And on top of that, there are physicians who don’t accept health insurance, or who only accept some forms of insurance. The doctor in my grandparents’ home town refused to accept Medicare right up until he retired. Many doctors refuse to accept patients on Medicaid.

So the only real answer to your question is, if you’re rich, live in a good area and need a specialist, you may have more health care than you need. If you’re poor, in a remote area and need primary care, you may find a shortage.

Anything beyond that goes into Great Debates.

3

I think I can provide a factual answer to this, which is, “No there are not too many doctors in the US. Nor can there be”.

My logic is this. Doctors are the segment of the population who are certified to have attained a certain level of knowedge and skills related to a specific field of endeavor. You can define plumbers or electricians the exact same way.

How is it possible that a set of facts be known by too many people? Or that too many people share some particular skill. I claim this is not possible.

It is certainly plausible that an economy cannot sustain as many paying jobs in a field as there are people who have training in it. Look at all those people (myself included) with liberal arts degrees in political science, history, English literature, etc. And it is equally plausible that the same economy can sustain more paying positions in a field than there are people with the training to fill them.

And you can make similar points about an educational system which, given the nature of a fluctuating economy, is constantly churning out people trained in particular field in greater or lesser numbers than the economy can absorb within those fields at the time.

So some people have to find work in fields they didn’t get such a high level of training for. An some emplyers have to hire people for jobs those people have little or no training gor, and either provide the requisite training or send them off somewhere else to learn what is needed.

The fact that there are people who have skills that they don’t use professionally does not make that training “wasted” in any sense other than a theortical one in a market-based study of a society at one moment in time.

Are there too many people who know trigonometry?

I believe this is a fact-based answer, but if someone wants to challenge me on it, I’m afraid we’d need to move to another forum.

4

In an ideal capitalistic system, there can be no such thing as a long-term glut or shortage in any profession. It will be perfectly balanced through the forces of supply and demand. As an example, if there are too few engineers, the wage for an engineer will be driven up. This will entice more people to pursue engineering, and thus resolve the shortage problem. If there are too many engineers, the wage for an engineer will be driven down. This will cause less people to pursue engineering, and thus resolve the glut.

As you stray farther and farther away from the embodiment of a pure, “laissez faire” capitalistic system, a country may start to run into glut and shortage problems. The driving force is usually the government (through regulation and laws), though industrial corruption and monopolies can also be a factor.

5

I dont know if i agree with that. Take nursing, which has a major shortage and a shortage that will get worse soon as nurses retire and baby boomers get sick. In my experience, for every 10 people that apply to nursing school only 4 get in. Of those 4 only 2 graduate. of those 2 only 1 will still be a nurse in 5 years. So even though there is a demand for nurses, and millions of people want to become nurses, there is too much red tape to wade through for supply to meet demand.

As far as US doctors, i’m pretty sure its alot less than 2.8 per 1,000.

http://216.239.41.104/search?q=cache:Y2slER58GJoJ:www.fraserinstitute.ca/admin/books/…&hl=en&ie=UTF-8

That is a chart of the top 20 countries doctor/patient ratios, the US isn’t on the list and #20 is Turkey with 1.3

I can’t find stats on US doctors however the Occupational Outlook Handbook says there were 583,000 doctors in the US in 2002. the US has a population of 288 million in 2002 giving a rougly 0.2 doctors per 1000 people ratio.

6

i think that should be 2 doctors per 1000 people, my mistake.

7

Wesley Clark: The supply and demand principle outlined in my previous post is always valid over the long term. For any occupation. Though it often doesn’t work perfectly. The “monkey wrench” is usually government-mandated rules and regulations. But not always.

As for nursing, my wife is a RN. She had a difficult time getting her current job, and she was an excellent performer in school. If there were truly a shortage, it would have been a cakewalk. She also says there is not a nursing shortage where she works. Now this is just one experience, and certainly does not imply a nursing shortage on a national level.

So you would first have to prove there is a nursing shortage. If you can successfully prove this, then you must look at nursing wages. Is there a correlation between the demand for nurses and rising wages? You should find one. If there is not a correlation, then you should find out why. If hospitals are demanding more nurses, would it not make sense that they’ll start increasing the wage they’re willing to pay?

Now let’s assume that hospitals have indeed increased the wages as a result of the nursing shortage. Now you should ask: Are more students enrolling in nursing school? They should be. If nurses were paid $200K per year, I can guarantee the schools will be filled regardless of entrance requirements. Because this is an obvious truth, any incremental increase in wages must also have the same effect.

Again, the system is far from perfect. But over the long run the above-mentioned principles hold true.

8

The nursing shortage is essentially a proven fact. Here is one of many, many websites discussing this issue

http://www.aacn.nche.edu/Media/Backgrounders/shortagefacts.htm

Not enough graduates (schools limit applicants, and many applicants drop out), people quitting after they join (usually due to being overworked)
and the fact that many nurses are near retirement all are parts of the shortage.

What you are saying (about wages and more applicants) has already happened. I have a friend in Minnesota who is trying to get an AS in nursing, she says only 2% of applicants get into that program. At the community college in my town only 30% of applicants got in. Local nursing jobs (union ones) where my friend lives start at $26/hr. Its not that there is a shortage of people wanting to get into nursing school, but most schools will only accept 20-30 students a year, and of those 20-30 only about 10-16 will graduate from what i’ve seen.

So the red tape of education prevents adam smiths invisible hand from working in this instance. Its like if there was a demand for spice in the US, tons of spice in China, but no boats to transport it. That is how the current nursing shortage works.

9

Yeah, but that is like the old joke about macroeconomists being so removed from reality: an economist is someone who hears that one man can dig a hole in 60 seconds, and then assumes that 60 men can dig a hole in one second.

Doctors, lawyers, and other highly skilled professionals aren’t like laborers. They take years and years to train. If the supply of doctors was purely dependent on market-driven wages (as opposed to personal factors such as a personal desire to help people, or family pressure to be a professional, or to follow in dad’s footsteps, etc), then one would expect that there would, in fact, be gluts and shortages of doctors. The market can’t respond quickly to wage pressures when it takes a decade to train someone to work in a given profession.

I cannot give a factual answer about shortages of physicians in the US as a whole, but there is indeed a problem with shortages of doctors in rural areas.

Here’s one report from 1999 that bonus Medicare payments to rural doctors is not actually inducing doctors to stay in rural areas. PDF from the General Accounting Office.

10

In addition to that, the cost of training a physician makes it nearly prohibitive to rapidly increase or decrease the number of students at a medical school or in a residency training program.

Most of the cost of educating a medical student comes from the state (for public schools) and from exorbitant tuition (i.e. $30,000/year) at private schools. Most (if not all) of the salaries paid to residents comes from Medicare/Medicaid.

11

Wouldn’t the US have been on that list then?

Looking at it, the list is of only select members of the OECD–Organization for Economic Cooperation and Development. And there’s only 30 OCED members. Table 11 at that link lists 27 OCED surveyed, but again the US does not appear on the list.

12

The U.S. is hardly an ideal capitalistic system. And its health care system is even less ideally capitalistic.

Medicine requires its practitioners (doctors and nurses) to have a high-level skill set that requires costly training and costly equipment. In an ideal capitalistic society, someone with a costly, high-level skill set should be able to pass their costs along to the consumer, especially since the high fixed costs mean all competitors will be forced to charge roughly the same in order to recover their costs.

However, the actual purchaser of health care in the U.S. is not commonly the payer (i.e., the government or insurance company.) They are large enough that they can refuse to pay the charge set by the professional.

At that point, the provider has only three choices: refuse to see those people whose payment is handled by a third-party payer; lower its rates, even at the risk of not earning enough to cover its costs; get out of the business.

If hospitals are demanding more nurses, would it not make sense that they’ll start increasing the wage they’re willing to pay?

Not if hospitals don’t believe they can increase their revenue enough to offset the increased expense of higher wages. They would instead attempt to get by with fewer nurses (reduced level of care) or replace highly trained, high-cost employees with lower-cost paraprofessionals (reduced quality of care.)

This probably would not be the first choice of many hospitals (after all, a hospital with a higher quality of service should be able to attract more patients). It certainly would not be the first choice for patients (why should a patient who is paying for health care through insurance accept a reduced level or quality of care).

13

Consider also that many professions take steps to legislate their “necessity” and thus reduce the “substitution” efforts of employers. Consider, pharmacists for example. Due in part to the efforts of pharmacists there have long been laws on the books which require a licensed pharmacist to be on the premises before a pharmacy can dispense a medication. Thus, no matter how much Osco, CVS or WallGreen might like to substitute a “pharmacy tech” for a true pharmacist they are prevented from doing so by force of law. The same can be said of many other (if not most other) trades and professions ranging from Real Estate Appraisers to Attorneys and Stock Brokers. Indeed, after “legislating their necessity” many professional advocacy groups then take the next step and make it more difficult to enter their profession. Again, in the case of pharmacists this has meant increasing the educational requirements so that a SIX year Phar-D degree is required rather than the previous five year degree. Nurses have been less effective in organizing in an effective manner to promote their profession than have some other groups. Thus, you can still become a nurse with a “two year” (which is really a three year with pre-requisites) ASN rather than four year BSN degree. Indeed, it can be argued that there are powerful interest groups ranging from the AMA to the hospital, and HMO organizations that would oppose nursing organizations lobbying for mandatory BSN degrees especially in light of the recent nursing shortgage.

I consider this to be an integral, fascinating, and little discused aspect of our modern capitalist system. Indeed, were I a noted Ph’D I might write a book called something like “The Secret Economy - how the licensing and regulation game is played in America”. This aspect of society struck me especially when my wife had a small mortgage brokerage business (five employees). The local mortgage brokerage lobby actually backed legislation which would have the effect of putting many smaller brokerages out of business (in the name of increased comsumer safety and heading off even more draconian regulation). However, in private many members freely admitted that the real intent of the proposed legislation was to put the “smaller” brokerages out of business because they undercut the “prices” of the larger brokerages. I found this to be comedically, ironic because larger banks and mortgage companies were pursueing similar legislation which would have the effect of hindering these “larger” mortgage brokers for essentially the same reasons. In fact, I can recall hearing an NPR piece several years ago that talked about how the AMA had lobbyied Congress to limit the number of MD interniships available as part of some bill (Medicare?) that was being debated. Of course their reasons for doing so was not referenced, but the limitation of supply (in this case of doctors) is a plausible explanation. If only Mr. Reagan were still around to explain this process in terms everyone could understand and care about!