> Judy's point is that the British system operates with a greater number > of doctors per head. I'm just reminding her that the two systems work > quite differently. True. But I said "than even the UK"; various European countries that place less emphasis than us (UK) on primary care, and indeed have no GP gatekeeper system, have more doctors per head than the US. But they are not, with the possible exception of Italy, oversupplied with doctors. > Answer number two is that you could increase the number of U.S. doctors > by having a new, nautical residency. Instead of four years in the > center of a U.S. city, you'd train for four years on a boat that could > be anywhere. I'm afraid I don't see how this increases the number of doctors available to anyone, and certainly don't see how it increases the number available to treat US patients (I say this keeping in mind your point that the US may despite having less doctors per head than the major European countries who do not use primary care doctors as gatekeepers, nonetheless be amply endowed... ). Indeed, I'd say it would diminish it. But perhaps there's something I haven't seen. ----- Original Message ----- From: "David Ritchie" <ritchierd@xxxxxxxxxxxxx> To: <lit-ideas@xxxxxxxxxxxxx> Sent: Sunday, August 20, 2006 7:50 PM Subject: [lit-ideas] Re: A Possibly Very Good Idea > On the doctor "shortage" look at this article closely: > > http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm > > What I see is a considerable increase in the number of doctors from 1.6 > per head to 2.7 per head and then a fall to 2.4 per head. There are > two kinds of "shortage": one compared with the peak number and one of > geographic distribution. The geographic distribution one is the > hardest to solve. Malpractice costs for a specialist are no lower in > the countryside than they are in the town, but income is considerably > less. The result is that big chunks of the countryside have no doctors > in those disciplines that are at high risk for a lawsuit--Ob/Gyn, for > example. > > What the article doesn't consider is retirement age, which varies by > specialty. Neurosurgeons, because they are sued so often and because > it's such a high-stress job, and because you need to be at the top of > your physical skills all the time, tend to retire earlier than say > pathologists. Thus there may be shortages even though the absolute > numbers suggest otherwise. > > Judy's point is that the British system operates with a greater number > of doctors per head. I'm just reminding her that the two systems work > quite differently. The British tightly restrict the number of > specialists and thus have large numbers of general practitioners > feeding patients (when necessary) into a small number of consultants' > offices. The U.S. system has many fewer gp's and many more > specialists. Here nurse-practitioners and osteopathic doctors and > chiropractors perform the role of g.p. for some people, but the real > issue is how many is the optimum number of doctors in each system. I > don't think anyone knows. > > Eric's suggestion can be put into practice without resolving the > questions above. My first answer is that the existing system could be > adapted. A friend of ours is always on call to be flown to medical > emergencies. She used to do so under the auspices of FEMA. Now, much > to her chagrin, she is funded by Homeland Security. She can be sent > anywhere in the U.S. or to places where the U.S. has, or wants to have, > influence. Yap, for example. If the government wished to, it could > expand this system. > > Answer number two is that you could increase the number of U.S. doctors > by having a new, nautical residency. Instead of four years in the > center of a U.S. city, you'd train for four years on a boat that could > be anywhere. Two or three or four boats perhaps. Mission of mercy > *and* more doctors. > > Answer number three comes from the other end of careers. Many doctors > tire of the business of medicine before their work days are done, and > so they take early retirement. To practice part-time makes no economic > sense because of the cost of malpractice and "tail" insurance (tail is > the insurance you have to buy to cover the years after you stop > practicing, years in which former patients could decided to sue you). > What my father-in-law does is volunteer his skills in medical missions > to Central America, paying his own way there and back. (My wife takes > vacation time to do this also). I can imagine a boat being staffed by > a rotating group of fifty five to seventy year old doctors who would be > happy to demonstrate some of the idealism that took them to medical > school in the first place. > > David Ritchie, > Portland, Oregon > > --------------------------------------------------------------- --- > To change your Lit-Ideas settings (subscribe/unsub, vacation on/off, > digest on/off), visit www.andreas.com/faq-lit-ideas.html > > > -- > Internal Virus Database is out-of-date. > Checked by AVG Free Edition. > Version: 7.1.394 / Virus Database: 268.10.9/417 - Release Date: 11/08/2006 > > ------------------------------------------------------------------ To change your Lit-Ideas settings (subscribe/unsub, vacation on/off, digest on/off), visit www.andreas.com/faq-lit-ideas.html