A Shortage of Doctors?
A recent CNN headline — "We don't have enough doctors" — is quite accurate. The explanation given for the M.D. shortage is completely wrong.
CNN notes the "health-care workforce shortage is 'more acute' in Black and brown communities." The black community represents 13 percent of the U.S. population, but only 5.7 percent of American physicians are black. The implication is clear: only black doctors should or can treat black patients or, at a minimum, will treat them properly.
This is racist dogma. The vast majority of American doctors (and nurses) are blind to skin color, religion, ethnicity, and even criminal behavior. Real doctors treat each patient as a unique, valuable individual without regard to demographics. When Dr. Hugh Mighty, senior vice president at historically black Howard University, says, "As the problem of Black physician shortages rise ... many communities of need will continue to be underserved," he insults every white, brown, Asian, Native American, and black physician in this country.
A National Institute on Minority Health and Health Disparities report confirms racial inequalities for health outcomes. Minority populations are sicker, die earlier, and pose a huge economic burden compared to the white majority population.
When CNN or some government entity claims that such inequalities are due to providers' racist behaviors and shortages of black doctors, not only are they wrong; they divert attention from the real reason. Poor health is largely due to socio-economic factors such as poverty, poor education, limited availability of healthy foods, and inadequate access to care providers of any color.
CNN is completely off-base on why there is a severe and worsening doctor shortage. The real reason is morale.
Care providers enter the medical field because it is a noble calling. Nurses and doctors used to be (note past tense) respected for their altruism and commitment to the individual patient. Patients welcomed doctors into their homes for house calls. Patients had faith in their chosen provider's training and judgment. Together, patient and chosen physician made personal, confidential medical decisions with no other (third) party involved. Patients had a medical right to choose, and physicians had authority that corresponded with their responsibilities. Physicians' work used to be highly valued both by word and deed — i.e., compensation, especially after years of relative poverty in school and post-graduate training.
All of this has been lost, distorted, or destroyed.
Now, there is the presumption that when a patient does poorly, it is automatically the doctor's fault. Government warns patients not to trust their doctors by enforcing clinical guidelines, algorithms, and crisis standards of care to "protect" the patient from the doctor.
Dr. Valerie Montgomery Rice, president of the Morehouse School of Medicine, was right when she said that the COVID experience "pull[ed] away the curtain" from healthcare. However, she attributed poor minority health outcomes to racism when, in fact, pulling away the curtain exposed the true cause for low morale and the resulting M.D. shortage: responsibility without authority.
A physician is held responsible for a patient's outcome. But the patient cannot choose his physician. The patient must select from a limited list chosen by the health plan.
The physician does not have adequate time to be with the patient. Providers must follow benchmark standards, viz., 15 minutes for an established patient. Failure to achieve the standards can produce a scorecard that could take away hospital privileges.
The regulatory burden takes away even more patient time from a physician. Before electronic prescribing, it required less than one minute to write an Rx and give it to the patient. Now (unpublished data) it takes roughly ten minutes to get through all the screens, security protocols, and data input to use e-prescribing. Keep in mind that the efficient physician has only 15 minutes total with the patient, and the doctor still must fill out insurance forms and HIPAA compliance directives!
The physician cannot choose the best drug for his patient — the pharmacy benefits manager chooses. During COVID, Washington decided medications for all Americans, one-size-fits-all. Physicians who tried to use their best judgment on a specific patient rather than follow Fauci edicts were stopped. Some were subject to disciplinary action, even firing.
The doctor does not choose the patient's intervention. The health plan and/or insurer decides what procedure will be performed, where, who does it, when, and even if it is done.
The patient or consumer does not pay the doctor or seller — the third party does. Washington dictates "allowable reimbursement" and then repeatedly reduces the amount.
The M.D. shortage ultimately leads to death by queue. Americans are dying waiting in line for technically possible care that does not arrive in time to save the patient.
It is no wonder more providers are taking early retirement or refusing to accept government-insured patients into their practices. Don't forget the thousands of doctors and nurses who were fired during COVID for using their own best medical judgment and exercising their medical autonomy. It is a wonder that any young person would choose the medical field knowing what is in store.
To cure the physician shortage, return authority to physicians commensurate with their awesome responsibilities, directly reconnect patients with their chosen doctors, eliminate third-party medical and financial decision-makers, and thereby restore providers' noble calling.
Deane Waldman, M.D., MBA is professor emeritus of pediatrics, pathology, and decision science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.
Image: Pkd2016 via Wikimedia Commons, CC BY-SA 2.0 (cropped).