The Doctor Shortage Is Not the Problem

We are told that a serious shortage of doctors is coming, all over the world. But maybe that’s not quite true. What is coming may be a shortage of medical treatment. There are many medical services that do not require a physician, and there are far better ways of training physicians than we practice. And that’s not even our main medical problem.

In the US, we handicap ourselves because physician training is so expensive. Many people who might become physicians opt out for that reason, and we are left with a worsening shortage. In addition, a newly minted physician in the US begins practicing with $200,000 in debt, which requires high income from the first, which we have to pay for. We could do a lot better.

In the nations with the best national medical services, the government pays for physician training. In those nations there is no big debt for the new physician—actually, us—to pay, and physicians earn a comfortable salary from the first without that sword hanging over them. They are not “rich”, but they are comfortably affluent. If they want to get rich, they cannot do it by ordering extra tests for us to pay for, so excess tests are not ordered.

In the nations with the best national medical services,
the government pays for physician training.

US government provision of physician training in a national medical plan would have at least five very significant effects:

  1. The high cost of training would no longer be a barrier to any potential physician or his/her family, whereas now a significant number of potential doctors cannot afford the high cost. The catch-22 of new doctors needing high income to pay off student loans would be ended.
  2. Since many more students would doubtless apply, the expected doctor shortage would be lessened or solved completely.
  3. The biggest effect would be felt in minority communities where lower income is more common, because many potential physicians never consider becoming a doctor because of the cost.
  4. By providing free training, the government can reasonably require that doctors serve some period in an underserved location, thus solving a longstanding problem as well as amortizing the cost of their education.
  5. The government could require that doctors who received government-paid training serve at salary, which should actually be done universally anyway. This would significantly limit the real costs of medical treatment.

The political wrangling
over health care in the US
is absurd.

The political wrangling over health care in the US is absurd. Republicans cannot logically argue that Americans are better off with our costly and inefficient system, which leaves many millions without insurance at all. They are absolutely certain—and completely wrong—that a well run national medical service would somehow throw us all in Stalin’s chains. The best medical services in the world prove otherwise, and the entire world is baffled by our attitude. The quality of medicine in national plans has been repeatedly rated as excellent, and every person is covered. Our medical costs are virtually double, yet we fail to provide coverage for many millions of Americans. When a serious medical need arises, uninsured Americans are forced to go to an emergency room, where the costs the public must absorb are very high.

The kind of physician training and the universal coverage that is found in every advanced country except the United States, if adopted here, would literally solve the three worst problems of medical care we have: (1) costs that are double what they should be; (2) millions without medical coverage; (3) the coming shortage of qualified physicians and other medical personnel.

There is only one political party that is preventing these common sense solutions.


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8 CommentsLeave a comment

  1. Couldn’t agree more. My late English Grandmother was saying this back on the 80’s.


  2. A good first step I think all sides could agree on is a sizable test program. We already have the mechanism in place: the Public Health Service Commissioned Corps. The program works, we just need to expand its scope and size. There is no need to create a whole new federal bureaucracy when we already have programs in place that can scale.


  3. I agree, David.


  4. Bravo! And we continue to eat junk food loaded with sugars that are addictive so we’re turning into a society of diabetics.

    Good thoughts here. Might there be a forward thinking state that would be up for trying this?


    • The federal government should have pilot projects to train doctors. If it works as well as it does in other countries, they could be scaled up. But the main problem remains our foolish insistence on private insurance at twice the cost.


  5. Reblogged this on Public Issues and Public Health and commented:
    An economic perspective for the benefits of universal coverage for the United States.


  6. Typical partisan finger-pointing. Do you really think that our health care system would be vastly improved, if only there were no Republicans?

    Demand for health care services are on the rise; providers are fewer in number, and declining. Simple economics: the “cost” will increase, unless we have fundamental reform in our medical educational system, our reimbursement model, and our American culture in which there seems to be less importance on personal responsibility.

    75 cents of every dollar spent on healthcare in America goes to care for chronic diseases (only a nickel is spent on prevention). 80% of chronic diseases could be virtually elimated if Americans exercised more, ate less, and quit smoking. There’s your reform.

    If we Amercians don’t like the cost of healthcare, maybe we should stop making lifestyle choices that make it difficult to live long, healthy lives.


    • Thank you for your thoughtful reply.

      I don’t for a minute think we’d be better off without Republicans. I do wish there were less far right nonsense, particularly the insistence that all would be better if only we all became responsible persons. What I think would vastly improve our health care system is a good national plan like all other advanced nations have.

      This essay is primarily about a way to remove one of the reasons our health care costs twice that of other advanced nations, the $200,000 debt that every doctor begins practice with. Removing that debt would alone bring down the cost of health care, allowing us to pay all doctors by salary, like other professionals. Private insurers contribute nothing at all to health care. What they do is remove their profit, which increases our cost.

      The drive among health care providers to promote those things you mention–exercise, diet, quit smoking, etc.–is one of the major medical successes of the past few decades, and one reason is that prevention is inexpensive. However, you can improve your life, but you can’t exercise your way out of arthritis, asthma, or hypertension, or any number of other chronic conditions, and the onset of many chronic conditions is not dependent on lifestyle choices.

      As for Republicans, I wish that more would be willing to entertain the possibility that other nations’ experience could teach us something about health care.


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