[lit-ideas] Re: A Possibly Very Good Idea
- From: "Judith Evans" <judithevans1@xxxxxxxxxxxxx>
- To: <lit-ideas@xxxxxxxxxxxxx>
- Date: Sun, 20 Aug 2006 21:22:01 +0100
> 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
>
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