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A Day Late and a Doctor Short

Posted on the 03 March 2013 by Fadi Bejjani @DrFadiBejjani

A Day Late and a Doctor Short
As detailed in Sunday's Los Angeles Times, facing doctor shortage, CALIFORNIAlawmakers are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetesand high-blood pressure. That has been their dream for years! Why not have podiatrists do heart transplants? Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Association of American Medical Colleges (AAMC).

Some of CHICAGO’s poorest neighborhoods are expected to see the greatest demand for additional primary care doctors in 2014, as the Affordable Care Act boosts the number of newly insured patients seeking medical services, a new study has found.

Englewood, with a median income of $34,000, for example, will see demand for primary care physicians grow by about 10 percent – the largest expected increase in 12 local areas examined in the study published last week by the journal Health Affairs. Nationwide, at least 7 million Americans live in areas where demand for additional primary care doctors will jump by more than 10 percent. BE CAREFUL WHAT YOU WISH FOR!

The ARIZONA Department of Health Services estimates there are 141 primary care shortage areas, 94 mental health care shortage areas and 154 dental care shortage area across the state. To remedy that, Arizona would need an additional 313 primary care physicians, 250 dentistsand 136 psychiatrists, especially the latter. Experts predict the problem will only get worse under the Affordable Care Act with Arizona expanding Medicaid.According to Rebecca O'hara, vice president of government affairs, Florida medical association (on Cavuto, 2/25/2013): FLORIDAis seeing an echo of what's going on nationally, except that it has some unique concerns that make it stand out with respect to physician work force shortage issues. Florida has a large number of people over the age of 65, a large uninsured population and a large percentage of Medicare recipients. Plus, said O’Hara “a lot of physicians are retiring and we are just not being able to keep up with the demand”.
A recent study in the Annals of Family Medicine estimated there are nearly 209,000 primary care providers in the U.S. With population growth, aging and the changes brought on by the Affordable Care Act, experts say today's shortage of 16,000 primary care physicians will grow to about 52,000 by 2050. According to AAMC estimates, the United States faces a shortage of more than 90,000 physicians by 2020a number that will grow to more than 130,000 by 2025. (AAMC's physician shortage estimates. )
Increased medical school enrollment is part of the solution to the addressing the doctor shortage.  The AAMC has called for U.S. medical schools to increase enrollment by 30 percent, and institutions are currently on track to meet that goal by 2016, according to AAMC's 2011 Medical School Enrollment Survey . NYU is even exploring offering a three-year program (probably by shortening sleeping hours and other leisure time!) Despite this increased enrollment, there are not enough federally funded residency positions for these new doctors to complete their training and become practicing physicians. Congress capped the number of federally supported residency training positions 15 years ago with the passage of the Balanced Budget Act of 1997.  This fact will worsen the physician shortage and jeopardize the health of patients around the nation.  IT TAKES YEARS TO TRAIN A DOCTOR.  It is a HUGE personal, familial and societal investment and an invaluable resource.
This last fact is the clincher, isn’t it? So why not acknowledge it and do something about it. There are many doctors nationwide who are being disciplined for some paper crime or another but nonetheless have vast experiences treating patients, spent an enormous part of their lives training and retraining and learning at enormous costs and sacrifice and partially at their country’s expense. After all, doctors are as a group the most educated people on this earth, and some even the most cultured…but of course they are still first and foremost human. So what if they made a mistake or two, who doesn’t? Their country needs them now and what better way to redeem their mistake? Those willing should be intensively retrained in primary care as needed and dispatched to where they are needed around the country (this type of semi-volunteering work should be quite redeeming). It is a much sounder, swifter, SAFER and logical solution than upgrading nurse practitioners or painstakingly waiting years for new docs to go through the pipeline.
Training down a notch or retraining is a lot easier than training up!
This message should be clear for those in our society whose sole passion and purpose in life is to harass, torture and discipline doctors, e.g. lawyers, administrators, medical boards, government agencies, carriers: One day any of them will need a doctor for sure and there will be no one around, so:
Don't Cut off your Nose to Spite your Face

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