… apparently the solution is to funnel even more of the revenue to excessive Executive Compensation in Managed Care firms and the insurers. {{ LOL }}
intercst
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Coincidence or cause and effect?
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The biggest opportunities for outsized profits come when customers have urgent needs and the owners of the provision (not the providers mind you) control the volume of provision. Meet the so-called USA health care system.
Public provision of the essentials of decent public health and healthcare is the only sane form of provision, and can easily accomodate private concierge care for those with the wealth and desire to have it.
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Physicians are like any other profession, baby boomer heavy and more retiring than entering the profession.
At the personal level, DW & I retired early because of the politics/business of medicine (local and national). Headache not worth it. Plus, big incentive to enjoy life now while we can.
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Good point.
And if one has the wherewithal–why not leave early?
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Yes, and one of the parts of the debacle we call US health care comes from the consortium of those who control how many medical schools are available to US students. The medical trade (monopoly) has limited the number of facilities available so that fewer students can become doctors in the US than in most developed nations. It was a running joke (although very real) that college graduates who had the means who could not find a place in US med schools would go to foreign schools for their training. Guadalajara was a big one when I was in school. Of course, getting licensing back in the US is a little more difficult from a foreign school, but it can be done.
We all want good standards for students so that we have good doctors, but limiting the number of training spots is not the best idea for a good health care system.
Pete
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I’ve said this numerous times so why not one more.
The number of schools and residency training spots are limited to a certain extent to the amount of patients/cases a future doctor is exposed to. Say to sit for you OB/Gyn board you need to deliver 1000 babies or sit for your ENT board you need to do 100 tonsillectomies. Local Med School U delivers 5000 babies a year and does 200 tonsillectomies. Enough for 5 and 2 spots respectively. So all the politicians and nattering nabobs see the decline in physicians, etc., etc., etc., and say let us triple the spots available. Ok, you still only have 5000 and 200 cases respectively, so by dividing by 3 you are left with 2 options. One, you either have to now triple the time spent in training to get to the target numbers or two, you produce a much less experienced/trained product. The first won’t fly because schooling/training is 7 years minimum now and you won’t to make it 12? The public doesn’t want option 2 either.
My old college and med school tried to shorten the time by having an accelerated med school. After 2 years of year round college (cramming 3 years into 2), you then started med school. Lopped 2 years off the traditional 8. Was stopped after about 5 years because of the high burn out/drop out rate.
It is like the old adage of 10,000 hours to become an expert. Some things can’t be rushed nor corners cut.
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The bottleneck is really at the residency level. After medical school the MD must complete at least a year of residency to be licensed. Congress controls the number residencies. If we want more doctors, congress has to spend more money. Congress Limits the Number of Doctors - by Justin Leventhal
There is a bipartisan bill in the senate to increase residency slots. Cassidy, Cortez Masto, Cornyn, Bennet Introduce Bipartisan Draft Legislation to Help Teaching Hospitals Train More Doctors and Address Workforce Shortages | U.S. Senator Bill Cassidy
Medical schools have been steadily increasing enrollments. But there is no point unless there are enough residency positions.
The insurers now control the contracts with the hospitals.
Doctor’s pay had been at all time heights relatively speaking. For that to begin to slide is okay.
But that does not mean insurers are not taking advantage of the rest of the revenues and more. Healthcare insurance companies are an indecency.