[lit-ideas] Re: A Possibly Very Good Idea
- From: David Ritchie <ritchierd@xxxxxxxxxxxxx>
- To: lit-ideas@xxxxxxxxxxxxx
- Date: Sun, 20 Aug 2006 11:50:41 -0700
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
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