Thursday, June 13, 2013

We do NOT have a physician shortage.

There is a continual stream of commentary detailing the impending collapse of the health care industry (not all of it unfounded). One persistent recurring claim, which I do take major issue with, is that we have a vast shortage of physicians which will only be exacerbated by Obamacare. This is a powerful complaint, as it is easy to see the fear it might provoke in people who were led to believe that access to health care is a zero-sum game. Expanding coverage to 40 million Americans under Obamacare, so the thinking might go, and people currently with ready access to physicians could be stripped of that. The whole mindset here is broken, and it makes me think of the anecdote about Milton Friedman in India:

Our friend the late Milton Friedman once told us a story of being in India in the 1960s and watching thousands of workers build a canal with shovels. Milton asked the lead engineer, Why don’t you have tractors to help build this canal? The engineer replied: “You don’t understand, Mr. Friedman, this canal is a jobs program to provide work for as many men as possible.” Milton responded with his classic wit, “Oh, I see. I thought you were trying to build a canal. If you really want to create jobs, then by all means give these men spoons, not shovels.” 

Right now, physicians in America are working with spoons.

If the expectation is that American physicians will continue to order so many unnecessary tests and studies, perform unnecessary or unproven procedures, prescribe unnecessary medications, engage in futile or inappropriate attempts to sustain life or limb, fail to implement new technology that might otherwise allow us to practice more efficiently, and adamantly refuse to have an honest conversation with the nation where we explain that there are limits to what we can do, that people must die someday and it doesn't necessarily have to happen in the ICU during a full code, and that we must set reasonable expectations for margins of error instead of demanding the near absolute diagnostic certainty that we currently do...then sure, in that case we have a serious physician shortage.

The solution isn't to train more physicians and hand them spoons.

1 comment:

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