[EDITORIAL NOTE: The TGB Geriatrician is a bi-weekly column written by Dr. Bill Thomas (bio) for Time Goes By to give us the information we need to help us navigate the health issues of aging. Dr. Thomas also writes his own blog at Changing Aging.]
USA Today goes in depth with a front pager on the issue of physician economics and the future of the aging baby boom. The story is a follow up on this earlier report:
"Millions of baby boomers are about to enter a health care system for seniors that not only isn't ready for them, but may even discourage them from getting quality care.
"’We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably,’ said John W. Rowe, professor of health policy and management at Columbia University.
“Rowe headed an Institute of Medicine committee that released a report Monday on the health care outlook for the 78 million baby boomers about to begin turning 65."
- USA Today, 14 April 2008
Here is the latest news:
"Medical students are shying away from careers in general internal medicine, which could exacerbate the U.S. doctor shortage expected by the time the youngest Baby Boomers head into their senior years, researchers report today.
“Only 2% of 1,177 respondents to a survey of students at 11 U.S. medical schools said they planned to pursue careers in general internal medicine, according to the new study…
“According to one estimate, the USA will have 200,000 fewer doctors overall than it needs by 2020, according to the new report. Meanwhile, the number of older Americans is expected to nearly double between 2005 and 2030.
“’Many medical students are turned off by the thought of caring for chronically ill patients and the amount of paperwork general internists must deal with,’ says lead author Karen Hauer, a general internist on the faculty of the University of California-San Francisco.
"’They rated the intellectual aspects of the field highly, and they rated continuity of care appealing,’ Hauer says. ‘When you put the whole package together, it's too hard.’"
“On top of the workload, a "research letter" in the same issue of JAMA as Hauer's study ranked internal medicine as one of the lowest-paid medical specialties…
“Radiologists topped Ebell's list, with a starting salary of $350,000, not to mention, Hauer notes, more regular hours than general internists.
“Their amount of debt [following medical school] didn't seem to influence their choice of specialty in her survey, Hauer says.
“Rather students focused more on quality of life factors such as income and work hours, which did steer them away from general internal medicine."
- USA Today, 9 September 2008
The problem with a health care system that is driven exclusively by the economic interests of the participants is that what the market rewards (that is, large numbers of radiologists) and what people need (large numbers of general internists) do not match up.
I raise this issue because it is a sub-species of the more general question, "Is health care a market good (like cars and candy canes) or is it a right?"
We as a society share the conventional wisdom that people do not have a "right" to cars and candy canes. If we want to have these things we have to pay for them. Health care is, somehow, different. Who would say that a child with pneumonia should be left to suffer because his/her parents cannot afford treatment. There is a law that requires hospitals to treat any person who comes to the emergency room, regardless of their ability to pay.
This reminds me of a bit of cynical medical humor I learned in medical school: Doctors who we thought were overly concerned with a patient's ability to pay were said to demand a "wallet biopsy" before they would be willing to accept the patient."
The profit motive has contributed to progress in medicine and the healing arts. I would not want to go back to a time when medicine was a small-time cottage industry of not very well educated physicians making use of a narrow range of not very effective treatment. It is also true that the market does a terrible job of matching resources to need.
So the wealthiest nation in the world is now facing the greatest age boom and will almost certainly live through it without the doctors we need.
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[At The Elder Storytelling Place today, Tom Speaks recalls his trucking days in Hard Working '50s.]