Map of life expectancy at birth from Global Education Project.

Wednesday, January 23, 2013

The doctor is out . . .

. . . but it's okay. Many have been viewing with alarm the current shortage of primary care physicians, and predicting that it's just going to get a lot worse. This is one argument advanced against the affordable care act. What's the use of giving everyone insurance if there aren't enough doctors for them all?

Green, Savin and Lu in Health Affairs (at least you can read the abstract) aren't so worried. Although insuring timely access to care -- it can take months to book a routine appointment nowadays -- would seem to make the problem even worse, it turns out that most analyses have been based on an overly simplistic assumption: that the supply of medical services is equivalent to X number of physicians per Y number of people. (1 per 2,500 is the popular choice.)

Actually, physicians nowadays are less and less likely to come as indivisible units; they more and more practice in teams, which makes it easier to match day-to-day demand with an available provider. Yeah, it might not be your regular doc but you don't necessarily need her for an urgent care visit. Even better, you don't need a doctor at all -- Nurse Practitioners and Physician Assistants can do 90% of the visits. It takes much less time and money to produce one than it does to put a doctor through 4 years of medical school and 3 years of residency; and even yet better, their salaries are lower, which is not entirely unjust since they don't need to repay $250,000 in loans or give up 7 years of their lives.

This is just one of many ways we can make health care better and cheaper in this country, while making it accessible to everyone. If we have the will, and if the people get it through their heads that nobody in his or her right mind would ever vote for a Republican.


kathy a. said...

i was very pleased at our old doctor's office, having a long-term relationship with a FNP. and i was dreading moving to kaiser -- which we did because it costs less, and i have actually gotten much more. most everything they refer can be done on site (instead of running around), often the same day (e.g., x-rays), very low copays. i can email my doctor! which is really good -- a lot of questions answered there, no need for a visit.

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