Sunday, April 26, 2009

Physician shortage, doctor shortage, regional variation - HEALTH REFORM CANNOT SUCCEED WITHOUT MORE PHYSICIANS

From: Physicians and Health Care, Commentaries by Buz Cooper, MD

Why are there shortages of physicians? Because health planners in the 1990s thought there were too many specialists and federal legislation was the number passed yearly. But why isn’t anything done about it now? Because voodoo statistics have convinced them (again) that there are too many. This blog will explain more about these statistics and about the damage that is occurring because of the failure to act responsibly on the behalf of citizens of this great damage. HEALTH REFORM CANNOT SUCCEED WITHOUT MORE PHYSICIANS.

Buz Cooper, MD, Prelude to his blog,

Richard (Buz) Cooper, MD is a Professor of Medicine and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania. During almost 50 years as a physician, he has practiced hematology and oncology, conducted experimental hematology research, directed a cancer center (at Penn), been dean of a medical school (at the Medical College of Wisconsin) and led a health policy institute (also at Wisconsin). Over the past 15 years, his efforts have been focused on critical issues in health care policy related principally to projecting the demand for physicians and other health care professionals and understanding the future dimensions of the health care system.

We bloggers have to stick together to achieve visibility in the sea of more than 2 million bloggers out there. Buz Cooper is one of the best of the physician bloggers because of his unique, strongly held, and well-documented views of the harm of the looming and growing physician shortage among all specialties.

His blog, now 2 months old, is not yet widely read, but it will be, when people realize as they are beginning to in Massachusetts, that universal coverage is meaningless with primary care access.

What Buz is saying is this: The disconnect between national policies based on theoretical assumptions resting on biased data interpretations divorced from reality (There are too many specialists, specialists are bad for quality, regional variations are unwarranted) and practical problems on the ground (I can’t find a primary doctor, there aren’t enough surgeons)CAN BE DANGEROUS TO THE HEALTH OF THE AMERICAN PEOPLE.

Here, to give you a taste for what Buz is saying are the titles and lead paragraphs of six recent blogs.

No One Home in the Medical Home

April 25

The ACP sees Internists as custodians of the “Medical Home,” a broad and inclusive model of care that is more conceptual than practical and only minimally tested among adult populations. Yet even if it proves to be valid, it faces the reality that there won’t be enough Internists, or Family Physicians, to make it happen.

This lack isn’t simply because Internists and FPs aren’t paid enough, although they aren’t. It’s because there won’t be enough physicians overall. There already are too few general surgeons and too few urologists, and the oncologists project a 40% shortfall within ten years. Faced with shortages like these, physicians will have to gravitate to roles that only physicians can play, while most of what goes on in a Medical Home is undertaken by Nurse Practitioners and others.

Let’s Talk About Poverty

April 23, 2009

Did you know that the poorest 15% of our fellow citizens consume more than twice as much health care as the richest? That means that if health care spending for everyone could be the same as it is for individuals at the median, our nation would consume 20% less health care. That’s a sobering reality.

Medicare is Not a Proxy for the Whole

April 20, 2009

The Dartmouth Doubletalker’s continue to insist that “state-level Medicare spending is closely correlated with overall per capita spending,” as it must be, because if Medicare and total expenditures don’t correlate, Dartmouth’s whole house of cards comes tumbling down. But they don’t, as clearly shown below, so watch out for tumbling cards.

A Tale of Two Cities: Birmingham and Grand Junction

April 14, 2009

The quiet of an Easter evening was shattered by a phone call from an irate surgeon saying, “did you see Peter Orszag’s Congressional testimony last year and the one by Elmendorf (his acting replacement at the Congressional Budget Office-CBO) last month?” Yes, I had seen both – they’re fundamentally the same. Both cite a 2002 paper from the Dartmouth group claiming to show that differences in illness rates among regions of the country account for less than 30 percent of the variation in spending. And they claim that differences in the income explain little more.

The MedPAC Squeeze: What’s at Stake for Rural America

April 10, 2009

Here’s what Tim Skinner, Executive Director of the National Rural Recruitment and Retention Network (3RNet), has to say about MedPAC, the agency that advises Congress on Medicare. MedPAC fully embraces the Dartmouth line that “more is less” (more physicians produce poorer quality) and has failed to promote greater support for graduate medical education (residency programs), which is the only source of new physicians in America.

The Paradox of Outcomes in Hospitals and Regions

April 10, 2009

A very good reporter asked a very good question. I had told him that one of the major problems with the Dartmouth group’s studies of regional variation was that their metric of health care utilization was the average level of Medicare spending in each region. The problem is that quality within regions doesn’t depend on Medicare spending alone – it depends on total revenues from all sources, and total spending doesn’t correlate with Medicare spending. This hangs as a cloud over their studies of outcomes among regions (see “30% Solution – A Treacherous Prescription”).

More Jobs, but not without More Physicians

April 7, 2009

In the month of March, the number of health care jobs increased by 13,500, bringing the total to more than 13 million, 12% of all jobs. At the same time, overall employment fell by 663,000, erasing the meager gains over the past decade and raising the unemployment rate to 8.5%, the highest in 25 years.

The 30% Solution – A Treacherous Prescription for Health Care Reform

April 5, 2009

According to a leader of Dartmouth’s Health Policy group, “if we sent 30% of the doctors in this country to Africa, we might raise the level of health on both continents.” Sadly, the notion that 30% of health care resources are wasted underlies current thinking about health care and serves as a beacon for Peter Orszag (Director of the Office of Management and Budget) and his health care reform team.

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