The Truth about Doctor Demand Dilemmas

As scarce as truth is, the supply has always been in excess of the demand.

Josh Billings (1818-1885)

As the physician shortage grows, technology advances, and government-subsidized care expands, the truths of the law of supply and demand become evident.

The demand side of the supply and demand equation states says that as the quantity of a good demanded falls, the price of the good rises.

Costs of care are rising, as premiums spike, often by 20% or more. Demand for physician services is growing. This demand stems from an aging population with more chronic diseases, technologies proven to alleviate those diseases, physician shortages across the board, expanding government programs - Medicare, Medicaid, and health exchange plans, more physicians not accepting those in government subsidized plans.

The truth is that the physician shortage is growing. It stands at 50,000 today and may exceed 100,000 by 2015. How could this be? Physicians are among the top 5 % in income, with top-earning specialists making $300,000 or more, and primary care doctors pulling down $150,000 or more. And physician recruiting firms report doctors finishing residencies get 100 or job offers, mostly from hospitals or large physician groups. These jobs generally come with health benefits , malpractice coverage, time off for vacations, and help paying off educational debt.

What’s not to like about becoming a physician? Well, as a recent “summit at the summit” meeting of physicians sponsored by United Physicians and Surgeons highlighted, there’s a lot not to like, including intervention into the patient-physician relationship, loss of physician autonomy, unreasonable credentialing requirements, unnecessary installation and use of dysfunctional electronic health records, time and effort spent searching for arcane IDD-10 codes to get paid, and second guessing at every step of the authorization of procedures and billing process.

The truth is that many, if not most physicians, are unhappy campers on the federal camping grounds. The truth is that health care has become a huge national business, consuming nearly 20% of GNP. The truth is that health care has consolidated into massive entities, with government, insurers, and large integrated health systems at the controls, rather than independent physicians in scattered practices. The truth is that costs of entitlement programs are becoming unsustainable, that something must be done to control costs, and that those controls begin with controlling physicians. The truth is that it is difficult, if not impossible for government, to dictate and monitor care from the top-down in a system involving billions of transactions at the bottom of the system.

The truth is that physicians are seeking ways through, out, and around the demands being placed upon them. These ways include becoming more efficient by using more physician assistants, nurse practitioners, and data scribes; opting out of the system by foregoing 3rd party participation and contracting directly with employers and patients; and going around hospitals and other competitors, by creating more focused, efficient, convenient physician-owned and directed facilities.
Where the physician Merry-Go-Round stops no one knows.