Some thoughts on the supply of medical services

From a recent survey discussed in the New England Journal of Medicine

• 72% of physicians feel that a public option would have a negative impact on physician supply, with 45% feeling it will “decline or worsen dramatically” and 27% predicting it will “decline or worsen somewhat.
• 24% of physicians think they will try to retire early if a public option is implemented.
• 21% of physicians would try to leave medicine if a public option is implemented, even if not near retirement age at the time.
• 36% of physicians would not recommend medicine as a career, regardless of health reform.
• 27% would recommend medicine as a career but not if health reform passes.
• 25% of physicians would recommend medicine as a career regardless of health reform.
• 12% would not recommend medicine as a career now but feel that they would recommend it as a career if health reform passes

While doctors are leaving the profession, it is difficult to get many new doctors in the profession.

The new federal health-care law has raised the stakes for hospitals and schools already scrambling to train more doctors.

Experts warn there won't be enough doctors to treat the millions of people newly insured under the law. At current graduation and training rates, the nation could face a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges.

That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.

The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. But the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007. . . .

One response might be to increase what nurses can do, but nurses are also in short supply. This type of deregulation should be done anyway. Not just because the government health care bill is going to make the supply of doctors even worse.

A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less. . . .