Few things are more frightening than knowing you live too far away from the nearest doctor. Yet in many rural or poor urban areas there are far too few doctors to serve the community, and the problem is getting worse.
Because the federal government has done too little in recent years to encourage doctors to take these less-glamorous posts, New York and other states are looking for ways to fill the gaps in medical care. Unlike some areas, New York is not lacking in medical school graduates; there are new interns out there in droves. The problem is that after they graduate, not enough of them decide to venture into the cold north upstate or the poorest urban neighborhoods.
Why should they, when secular society places the highest value on personal gain.
[i]Because the federal government has done too little… [/i]
There’s a whole world-view embedded in that phrase. Note that complex cultural, social, and economic factors dovetail into the simple [i]because[/i] of a simple answer: the government must do more. And not any government, but the federal government. Local communities that need doctors aren’t responsible to attract doctors.. The government – the [i]federal[/i] government – must do more. Moreover, the article continues discussing a state initiative that’s good, but clearly not enough. Obviously,we needs the feds.
Actually, the federal government has done [i]too much[/i], not too little. The result is that the vast majority in the poor sections of the country are medicare and medicaid patients, and not only do the government reiumbursements [i]not cover the cost of overhead and malpractice[/i], but even then, the regulations on the physician in dealing with the government patients make it no longer of interest to physicians who [i]didn’t get into medicine in order to be a government employee.[/i]
As noted, medicaid and medicare do not cover office costs. Especially medicaid, which is charity in all but name.
Not only is medicaid and medicare charity, but in addition, patients are instructed to “watch for medicaid fraud”.
Some examples of “medicaid fraud” is letting the poor working poor smuck who does not qualify for medicaid see the doctor for free, or at a reduced price. If you do this, you are commiting fraud, because the US government is no longer getting your lowest price.
Whistleblowers to rat on docs who see folks for free in their office get a large percent in anything the government recovers on such purported “fraud”.
Personally, I would be very happy to be a governmental employee, if I received the hours and benefits of the usual VA physician.
When I see med
Same reason there is no Starbucks in the rural.
Why not repeal the thirteenth ammendment and draft doctors to live and work where no one else wants to live?
Good heavens, clueless. That’s horrifying. You can’t do pro-bono medicine?
I do not look forward to going on Medicare in a few years. It is not unusual for people to have trouble getting medical care in a new area, because doctors, reasonably, don’t want patients whom they treat at a loss. What is frustrating is that Medicare patients with money can’t pay the difference to get the care. And this is what medicine will look like if a single-payer scheme gets implemented.
This article made me think about Northern Exposure and Dr. Joel Fleischman, from the early 90’s. What a great TV show that was.
6 no, it will be worse, as the effects of undercompensation of the medical system will be spread over a wider population. The only hope for a single payer system (or any managed health system) to cut payments is to cut its real expenses. So, it either has to cut services, research, or administrative costs. Your point and mine is that cutting services and research causes drops in quality of service and the health outcomes for the patients. But, to date, none of the proposed public, and 99% of the private managed care plans, have failed to say how they will cut administrative costs. But it is in the ballooning of admin costs that motivates the growth in overall health care premiums in such managed care programs. Going to a government run single payer or single entity system just takes away all external controls over this cost growth process.
5 why not just increase the immigration quota for physicians who agree to live for some period scarcity areas? Or simply give a government subsidy to those US docs who do? We already subsidize the farmers to live there, so why not subsidize the doctors to keep them healthy?
You can do pro bono work, but not in the office. I could go work at a free clinic, however my malpractice insurance will not cover me if I work at a free clinic, and the patients at free clinics are quite litiginous.
When I retire, I hope to spend time out of the country seeing patients for free. It would be difficult in todays climate to do so in the US. (I do make a point of leaving room in my schedule for 3 new Medicaid patients a week (which is essentially charity) and I see Medicare patients on the same basis as regular patients (I almost break even on them in terms of office expenses).
Increasing immigration quotas for physicians should work pretty well, mostly because foreign trained physicians do not have the medical school debt of US physicians. (It will put the US schools out of business, but maybe that’s a good thing, I don’t know).
What would be best is to decrease regulation. Currently office overhead averages between 130,000 to 180,000 for most physicians (not counting medical school debt with averages 150,000 ).
One needs to bill about 300,000 in order to net about 130,000.
(This is before the physician makes a dime).
The biggest factors driving cost are the keeping up with regulations, malpractice insurance and documentation to avoid liability. A no fault or “loser pays” system, and lower regulation would decrease costs. A promise of state immunity for physicians who move to rural areas would also lower costs (and be quite attractive).
Shari
#9, You already see that in some rural areas of Texas, where there are a growing number of foreign born or trained physicians.
Nos. 9 and 11, to take what you said in a little different direction, I don’t think the answer is to essentially screw U.S. citizens who took the time and expense to go to a quality American medical school by simply importing vast numbers of foreign physicians who will work in conditions American doctors won’t.
Also, I think this will spark a much deserved backlash. I for one will not be treated by foreign doctors, because I do not believe that 18 months at New Delhi Upstairs Medical College is at all equivalent to 4 years at Tulane University Medical School.
Well, I disagree. I think there are many very fine foreign physicians, and that some schools in India are very equivalent to those in the US. (There are others that are pretty worthless, however).
Whether the US should rape Third World nations of their physicians, after those Third World nations have spent money on the subsidized education of their own physicians is another matter. This essentially transfers wealth from poor people in the Third World who paid for the education of their physicians out of their meager taxes, to rich people in the First World who did not.
However, I suspect that in 10 years the “primary care physician” will be a nurse of some sort, and this will result in much cheaper medical education, since four years of nursing costs less than 8 years of college and medical school, not to mention residency.
To “Ouroboros” What, pray, will you do when there are no physicians other than foreign ones in your local area?
The reason I see kids is that if I didn’t, the nearest other neurologist who will see them is 200 miles away. Most kids with significant neurological problems are on Medicaid. When I retire, some kids will die. I would be delighted to have a “foreign physician” with an interest in neurology set up shop in town, and see kids also.
Shari
No. 14, we may be substantially in agreement here, with the exception of my lack of willingness to equate medical training in the U.S. or Western Europe with that of the Third World.
I agree that an added dimension is the “brain drain” you describe, and I stand with you in deploring what it does to developing nations. What I might view as a substandard medical education here might very well be stellar (and the difference between life and death) in Africa or Asia.
I shudder to think of primary care being offloaded to nurses, indispensable and respectable though they are. Nurses are not physicians, and wishing them so won’t make them so. However, their liberal use as “physician extenders” would be welcomed. More basically, however, we need to fix the economic imbalances in our health care system which are making medicine less and less attractive — no, strike that, less and less *livable* — for health care practitioners. A good start would be: (1) a cap on non-economic damages in malpractice suits; (2) expansion of medical savings accounts, including making them available to every working American, allowing the balance to roll over from year to year, etc.; (3) enacting tax advantages for those who coupled MSAs with high-deductible insurance plans; and (4) extending the same workplace labor laws that apply to all other working Americans to physicians. All this should be coupled with an aggressive campaign of educating the public that non-emergency healthcare is not a “right,” but is their responsibility to plan and pay for absent true and unforeseen calamity.
You see, a major part of our so-called healthcare “crisis” is that people do not view or use medical insurance in the same manner that other insurance is used. They expect it to kick in at “dollar one,” and see little to no personal responsibility to plan, save and pay for their healthcare. I ask you, do any of us treat any other area of our lives that way? When you have homeowners’ insurance, do you file a claim when a minor earthquake breaks $400 worth of glassware? Of course not; you pay it out of pocket. When you have automobile insurance, and take your car for a routine oil change, preventative maintenance, replacement of bulbs, etc. — do you file a claim? Of course not. You realize — we all realize — that these minor repairs and preventive acts are ours to pay for. Yet, this reasoning goes out the window when it comes to healthcare and medicine. We expect our insurance to pay for routine office visits; new glasses; the $40 prescription of amoxicillin when we get strep throat; the routine allergy meds in the spring; yearly teeth cleanings, etc. — and if it doesn’t, we scream and holler and demand government intervention because, after all, “healthcare is a right!”
This disconnect does not represent all of our healthcare problems, by any means, but it represents a major chunk. If we could simply get it through the heads of Americans that they should expect to spend on their own healthcare at least as much as they spend on the family vacation, Christmas, and new electronics every year, and reserve insurance for true calamities like a car accident, cancer, or major surgery, we would be well on our way to having the resources to hire more professionals, fund more hospitals, and save government intervention for those truly too poor to assist themselves.
Amen, #15.
On Indian doctors: I didn’t know until I lived there that Indians go directly into medical school from high school. They do not go to a four-year university degree and then medical school as we do. The high school programs (these will be private schools) are run on the British model or the IB model. Most students learn by rote and spit back quantities of information on standardized exams. Will doctors without a university education be as well-prepared as U.S.-trained doctors? I don’t know. Physicians, do you have an opinion?
Katherine, on the whole, the international medical graduates (IMG’s) who manage to get to the states and fulfill all the requirements to practice here (which includes taking all three levels of the USMLE and usually redoing a residency) are the cream of the crop and would have more than excelled if they had gone through the American style system from the get-go. The main issue was English language skills and that has been addressed.
I agree with #17.
While it is true that Indian (and British) physicians enter medical school following high school:
1. A “high school” graduate in India has the equivalent of what we call the international baccalauriate which equates to 2 years of US undergraduate.
2. A high school graduate in India got there in schools that are the equivalent of US college prep private schools, without the frills. Anybody who was a discipline problem, was lazy, unmotivated, had trouble keeping up washed out of the system beginning at age 11 (with the 11+ exams). Thus high school grads in India are an order of magnitude smarter the their football and cheer squad US counterparts. If they had spent their evenings at the game instead of at their books, (or if they had been working) they wouldn’t have graduated.
3. Although India and other Asian countries do emphasize content mastery, including rote memorization, personally I think this is a good thing. In point of fact, there is a lot of content to memorize in medicine, and self esteem does not get you very far in mastering it.
4. Those who come here tend to be the most ambitious of the lot, which usually equates to smartest.
5. Once they come here, they need to not only pass the English proficiency, but have a minimum of three years of US residency, and up to seven if they are doing something like neurosurgery.
Yeah, I think they’re usually pretty good.
Oh I might add that I went to a US six year medical program myself. After high school (Northwestern University Honors Program in Medical Education) students whose scores and transcripts essentially fulfilled the requirements for the international baccalauriate did two years of undergraduate, and then four years of medical school.
S.
Thanks, Robroy and Clueless. It’s good to know. The reason I asked was not prejudice against Indians. My husband had trouble hiring qualified engineers in India. They went the route, but had rote learning only, and had great difficulty doing anything that wasn’t “in the book.” We did have experience with excellent doctors while there. Like most things in India, there seem to be two tracks — one, top quality, and the other, for the rest.