[lit-ideas] Re: A Possibly Very Good Idea
- From: "Judith Evans" <judithevans1@xxxxxxxxxxxxx>
- To: <lit-ideas@xxxxxxxxxxxxx>
- Date: Sun, 20 Aug 2006 21:46:05 +0100
Oh wait, I see
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.
means that there'd be the same number of training places
available within the US but also, training places aboard ship.
This training would have to be at post-graduate/house officer
etc, level, so the doctors would have to be paid. I doubt the
US can afford to spend much more on medicine (broadly
defined) than it does now, so, don't quite see how such a system
would come about.
----- Original Message -----
From: "Judith Evans" <judithevans1@xxxxxxxxxxxxx>
To: <lit-ideas@xxxxxxxxxxxxx>
Sent: Sunday, August 20, 2006 9:22 PM
Subject: [lit-ideas] Re: A Possibly Very Good Idea
> > 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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