There doesn't have to be a doctor shortage

James Pethokoukis writing at AEI pokes a few holes in the idea that there is going to be a serious shortage of doctors in America in the coming decade:

In a decade or so, according to the Association of American Medical Colleges, the US may find itself needing 130,000 more doctors than medical schools will be producing. Higher demand will come from an aging society and millions more Americans with health insurance thanks to the Affordable Care Act. So are we moving from a health insurance crisis to a healthcare access crisis?

All else equal, perhaps. But all else is rarely equal or static in a dynamic economy like America's. AEI's Scott Gottlieb and Ezekiel Emanuel argue that "new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness." Also important is having non-physician medical personnel do more. But both innovative solutions could be stymied by government:

The opportunity exists to deliver more services and care with fewer physicians, but it's not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.

This is the best way to bend the cost-curve down in health care; innovation and getting government out of the way. But, as Gottlieb and Emanuel point out, part of the problem are the specialists:

- Going beyond current licensing, consider changing many anticompetitive regulations and licensure statutes that practitioners have used to protect their guilds. An example can be found in states like California that have revised statutes to enable highly trained nurses to substitute for anesthesiologists to administer anesthesia for some types of procedures.

- Make fuller use of technology to enable more scalable and customized ways to manage patient populations. These include home care with patient self-monitoring of blood pressure and other indexes, and far more widespread use of "telehealth," where, for example, photos of a skin condition could be uploaded to a physician. Some leading U.S. hospitals have created such outreach tools that let them deliver care to Europe. Yet they can't offer this same benefit in adjacent states because of U.S. regulation.

We have barely tapped the potential of the internet as a tool in healthcare. Care must be taken, however, not to become too enamored of technology lest doctors lose sight of the patient's needs.

One thing for sure; none of these reforms will take place as long as Obamacare is the law of the land. The kind of top down management of the healthcare system represented by Obamacare will do little to address the potential doctor shortage and will have a minimal effect on rising costs.





James Pethokoukis writing at AEI pokes a few holes in the idea that there is going to be a serious shortage of doctors in America in the coming decade:

In a decade or so, according to the Association of American Medical Colleges, the US may find itself needing 130,000 more doctors than medical schools will be producing. Higher demand will come from an aging society and millions more Americans with health insurance thanks to the Affordable Care Act. So are we moving from a health insurance crisis to a healthcare access crisis?

All else equal, perhaps. But all else is rarely equal or static in a dynamic economy like America's. AEI's Scott Gottlieb and Ezekiel Emanuel argue that "new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness." Also important is having non-physician medical personnel do more. But both innovative solutions could be stymied by government:

The opportunity exists to deliver more services and care with fewer physicians, but it's not a foregone conclusion. Policy changes will be necessary to reach the full potential of team care. That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.

This is the best way to bend the cost-curve down in health care; innovation and getting government out of the way. But, as Gottlieb and Emanuel point out, part of the problem are the specialists:

- Going beyond current licensing, consider changing many anticompetitive regulations and licensure statutes that practitioners have used to protect their guilds. An example can be found in states like California that have revised statutes to enable highly trained nurses to substitute for anesthesiologists to administer anesthesia for some types of procedures.

- Make fuller use of technology to enable more scalable and customized ways to manage patient populations. These include home care with patient self-monitoring of blood pressure and other indexes, and far more widespread use of "telehealth," where, for example, photos of a skin condition could be uploaded to a physician. Some leading U.S. hospitals have created such outreach tools that let them deliver care to Europe. Yet they can't offer this same benefit in adjacent states because of U.S. regulation.

We have barely tapped the potential of the internet as a tool in healthcare. Care must be taken, however, not to become too enamored of technology lest doctors lose sight of the patient's needs.

One thing for sure; none of these reforms will take place as long as Obamacare is the law of the land. The kind of top down management of the healthcare system represented by Obamacare will do little to address the potential doctor shortage and will have a minimal effect on rising costs.





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