Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need. [emphasis added]
After Years of Quiet, Expecting a Boom in U.S. Medical Schools - NYTimes.com
It is just so American to see a special interest group wrangle hundreds of millions of dollars based on something that looks good on paper but doesn't bear up under scrutiny.
Medical schools and their national association must be just so thrilled at dollars they will reap through their expansion plans. There may be a good case behind this expansion but this article like many cites the primary care shortage as one of the key arguments in favor of the expansion.
This is a specious argument and must be called out every time it appears. The primary care shortage is not due to a deficiency in US Medical School students. These students avoid primary care like the plague because their exploratory rotations with existing primary care practices expose them to professionals who have been degraded to hamster-wheel-running drones forced to suck up to insurance companies and hospital system masters who focus on dollars instead of care.
This issue has been heavily covered in blogs but the mainstream media keeps parroting the specious argument. (To be fair ANEMONA HARTOCOLLIS did find counter opinions, but that part of the article was anemic compared to the host of pro-med school quotations, and the counter position missed the issue I write about here completely.)
If medical students don't choose primary care because it is repugnant how in the world would building more medical school slots help solve the problem? Some bright person out there is probably thinking "Well, if 2% choose primary care we'll see some increase if we build more medical schools.'
Yes of course that's true but the dollars spent on this strategy could go a long way to addressing the root cause & thus effect a much greater increase in primary care supply.
If health care payers shift an additional 5% of the overall health care budget to primary care we'd be adequately funded to:
- Get off the hamster wheel and actually spend the time out patients want and need
- Hire the multidisciplinary care team so that we'd really be able to manage care across the continuum
- Purchase technology that really improves our ability to care for those we serve
It's possible. We see it in employer delivery systems like QuadMed, we see it in the data of the IMP grant, we see it in the experience of consumers in direct practices.
It's possible if self funded employers stop buying crap from the usual suspects and start exploring exemplary primary care delivery coupled with catastrophic or high deductible plans.
Another of the many ways that shifting funds into cognitive primary care would cut costs and improve access to care: Primary care doctors who have far-above-average income do so by running a diversified business of labs, tests, and procedures. If those services paid less well relative to cognitive services, some of those doctors could and would move back into using their education to care for patients rather than figuring out how to make more profit off of services that they now hire mid-levels to order so they can get their cut. When they return to caring for patients, the patients get higher-level care, there is less pressure to order needless tests, and there is improved access to care. Right now, the system is pushing expensively-trained medical doctors to become corporate managers. Is that really how we want to use that education?!
Posted by: John Haresch | February 15, 2010 at 02:09 PM