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Physician Shortage? What Physician Shortage? — Physician’s First Watch

Medical News |
December 6, 2013

Physician Shortage? What Physician Shortage?

By the Editors

A New York Times opinion piece lays out why the predicted shortage of physicians may not drastically affect medical care in the U.S.

The population is aging quickly, Scott Gottlieb and Ezekiel Emanuel write, but many patients can be treated in subacute facilities instead of hospitals. Evolving technology has meant fewer doctors are required to manage each case.

They conclude: "Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other health care workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better."

Gottlieb and Emanuel served, respectively, in the George W. Bush and Obama administrations.

Reader Comments (16)

Ron Newman Other, Unspecified, multple

Having had 77 surgeries over a 56 year period I feel I am qualified to give an opinion.I feel that the people who somehow make their way to the top of the chain in the governing body support themselves long before taking care of the staff who work the hospitals and patients in suffer from the cut backs because the funds are not there because of the abuse of the system from the upper chambers who say they are handling the situations. Meanwhile they putting through ridiculous pay increases and when the sh.t hits the fan it's I didn't do that or worse they resign and get a package which all comes from the tax payer who unfortunately in my case is also has been a patient and still has to rely on the system occasion. I think we have a better system here in Ontario than as they call it Obama care, But for how long if these others keep bleeding it and lining their own pockets. That's my opinion from where I have watched for some 50 years. Its not about care as much anymore as is the all mighty dollar and that is wrong. Thank-you

Kerry A Willis MD Physician, Family Medicine/General Practice, Beaufort NC

One of the best comedy pices written tongue in cheek that I have ever encountered. To think that two gentlemen who spent their time in government service decreasing the productivity of Doctors by increasing the adminstrative burdens they face is a dead giveaway that they can't be taken seriously. I commend them for their sarcasm and wit and think they should not make such an attempt in future writings to conceal their true thoughts and motives. This is really funny stuff when all the initiatives that the proposed are delayed because the technology to implement them doesn't exists and the financial systems to support them were not developed...The did such a great job that so many folks responded in a manner that would seem to elevate these gentlemen to expert status when they have earned scorn and contempt.

Richard Federbush MD Physician, Internal Medicine

"Other Health care workers" most definitley have their place, but they cannot replace a well trained physician. There is most definitley a physician shortage!

kisia abok Physician, Internal Medicine

Instead of opening new colleges, We should focus on new technology which can increase accurate and prompt diagnosis thereby increasing the productivity of existing physicians and other health care workers. Although I am 60 and above and still academically active, I can get a job because of my age in Kenya!

kinfe gebeyehu Physician, Pediatrics/Adolescent Medicine, emeritus attending Stroger Hosp. of Cook County, Chicago

I some what differ with the statement in my priority placement of medical care in the nation. I do support continuation of medical technology advancement at a rate it significantly promotes preventive medical care and detection and treatment of presently untreatable or less effectively treated diseases and conditions. I would not however consider such expenses should be at the cost of man power for medical practice because the practice of medicine goes beyond direct clinical to research, teaching and skillful utilization of the new technology. The aging population would sure need the human factor in dealing with problems of aging and problems of psychosocial nature. The cost of care of largely mechanized medicine where technology dominates to my mind will likely sore as well, much more than what the last 30 years of experience have shown us
Kinfe

PETER LOEB Physician, Gastroenterology, THR Dallas

I agree we should increase productivity of physicians.
However, EMR which is not integrated between physicians, other health care providers, laboratories, radiology and hospitals. EMRS by the thousands are bought at unreasonable costs without concern about these critical interrelations. The government is allowing industry this random grow without any apparent over site of efficiency and cost.
This has decreased my work efficiency by 20% during my 50-60 hours work week and added about 2 hours of computer work after hours. Because transfer of information is delayed, repeat labs and X-rays are required, increasing the cost,time spent, and delaying proper evaluation and treatment.
Most importantly, the care of patients is becoming increasing depersonalized as physician, nurses, and office staff race through the patients to increase "productivity" . "Abdominal pain evaluation required more than an algorithm for accurate
and cost effective care" -

Frances Ilozue Physician, Family Medicine/General Practice, AMA Community Health Advocacy Group

Very interesting idea from individuals who have no clue what it takes to "care for real patients by a real doctors". However, it's time to stop "throwing away the baby with the bath water" (email me if you need to understand this rural African adage.
I will challenge Gottlieb and Emanuel to sit down and have a candid discussion with the "Community health advocacy group" from American Medical Association. They need to understand why implementing ACA is almost impossible unless certain concerns are addressed. How do you ignore the concerns from the most important group who could help promote ACA and hope for an easy pass? The dream of improving quality while controlling cost will remain far from reality unless physicians lead the way in healthcare reform. Good luck!
Frances ILozue, MD
Solo Family Physician, Buffalo NY (60 - 70% Medicaid population) and Community Health Advocate

Lina Talbot MBBCh MRCP Physician, Internal Medicine, Retired

In fact, as the UK's National Health Service has discovered, the complexity of ill health in the older generations requires more physicians, and the involvement of more specialties to both diagnose and find solutions to multiple interacting health conditions.

THOMAS HUGHES Physician, Gastroenterology

With more emphasis in public education on algorithms and digital data entry, self-administered medical management should be within the reach of anyone. How's that for a new paradigm of efficiency?
By the way, did someone cloak these two in legitimacy or did they dress themselves?

Roger Beneitone Physician, Internal Medicine, primary care medicine ofice

I respectfully disagree. As our population ages and patients become more complex we need more primary care physicians who can spend more time with their patients. I find that technology cannot replace the time needed to discuss treatment options with patients. Caring for human beings takes time. No technology can replace the relationship one has with their patients. I actually find the technologies that have been introduced into medical practice , i.e. electronic medical records make me less efficient and does not increase the quality of care that I deliver. Nothing can replace a knowledgeable and compassionate physician who spends time with their patients. Caring for human beings is not a business or an industry , it is a calling.

Robert Stankewitz Physician, Internal Medicine

This column is sheer madness. Where do these theories come from? I truly need to know. Yes of course your assumptions are ALL correct. The health care delivery " system" in this country is an embarrassment - much like your comments, public education, and the effectiveness of this country's executive & legislative branches.
Your opinion needs more elaboration. You truly believe that as America gets older, fatter, lazier and sicker that the number of current physicians can accommodate the entire population - all because of technology. Interesting theory. Well maybe you should experience all the efficiencies of the technology already in practice in medicine today. You honestly think that adding another layer of software engineers, IT professionals and developers has made physicians more efficient to date. I would love to review the survey of physicians you believe are more efficient with the new technologies.
Before you legislate to create more Physician assistants and Clinical Practicing Nurses to "cover up" the physician shortage - you should apply your theory to your profession and maybe one more before passing this on to the American Physicians's back.
Your theory could easily be applied to journalists as well. Technology worldwide could be left to one journalist per continent.
Better yet - why not force technology down the throat of practicing attorneys. That should make them more efficient. Maybe we should open MORE law schools because only MORE lawyers seem to be able to efficiently and inexpensively resolve all of our society's problems as you well know.

Robert Nasser MD Physician, Ophthalmology, Pvt Practice, Univ affiliated

The authors need to try to obtain an appointment with a local primary care doctor or with a specialty physician for a referral. The wait (if available) is long. Perhaps the priveleged authors live in a more rarified environment than that of many of our citizens.

Lynn Li MD Physician, Internal Medicine, Umass

I completely agree. There are many non-MD tasks giving to us. If I could just do doctor's work, but have a scribe, a data enter clerk, a computer fixer and an user friendlhy, reliable, efficient Electronic Medical Record, i can see many more pts.

Ira Garoon Physician, Ophthalmology, Office

When was the last time either of these gentlemen practiced medicine. Their policies of forcing doctors into computers without the forethought to get the computers to communicate shows their ability to push through policy without thought of the problems to be amazing. And the computerized office has made offices less efficient not more. And at a significant cost. Sure, it's easy to say let's get doctors to be more efficient. It's just they don't have the ideas to do it. Before these two put through any more policies that can't be sure to help doctors maybe they should spend a few weeks in a medical office and see how destructive they can be. They are more than welcome to come to my office.

ERIC CHAN Physician, Internal Medicine

Do Gottlieb and Emanuel think that physicians can increase productivity beyond seeing thirty patients per day? Perhaps they would like to be treated by their physicians during three minute office visits as well.

David Physician, Surgery, General, Spain

I cannot stop laughing "...we should focus on increasing the productivity of existing physicians .." Maybe I am not as bright as supposed but I cannot catch this joke. How many psycopaths are lurking easily among politicians? Or is it more a matter of dull callousness that boosts this kind of nonsense? Yes, we can low down the doctor population in order to spare more money, increase the overpressure on the healthsystem and then give the doctors all the responsabilities of this policy failures. I don' t understand how it comes to be that politicians can botch everything and stay devoid of any consequence. Frankly, do we need to keep so many of them as to bear their jives on a daily basis? I am bracing for the worst.

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