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Residency Shortage + Healthcare

Discussion in 'Tilted Philosophy, Politics, and Economics' started by genuinemommy, Nov 5, 2013.

  1. genuinemommy

    genuinemommy Moderator Staff Member

    How has the doctor shortage affected you?
    What is your solution?
    Who should solve the problem of residency shortages?

    This is a topic that hits close to home. I have highly-qualified friends who have recently finished their MD but cannot land a residency.
    While there are more med students than ever before, there has not been an increase in the number of residencies. This means that there are people with MDs out there who want to practice medicine and are barred from doing so because they cannot take this next critical step of getting a residency.
    The current drive to get more people insured with basic medical coverage has only exacerbated the issue.
    Check out this recent report from the Association of American Medical Colleges:
    https://www.aamc.org/download/286592/data/

    And here are some news articles on the issue:
    The Shortage of Medical Residency Spots: A Failure of Government Control - Forbes
    http://www.nytimes.com/2013/08/23/us/shortage-of-doctors-tough-to-fix.html?_r=0
    ----------------------------------------------------
    I'm getting really frustrated with my own health care. I have recently been struggling to find a primary care physician that has any openings for new patients within a 30-mile radius of my home. I'm also on the search for a new Ob/Gyn and have experienced similar difficulties finding anyone accepting patients.

    Then I think of my friends with MDs who have tried for the past 2 and 3 years to land themselves residencies, with no luck. If they and others like them were able to get residencies, would there be a shortage?
     
    Last edited: Nov 5, 2013
  2. Baraka_Guru

    Baraka_Guru Möderätor Staff Member

    Location:
    Toronto
    Doctor shortages are an issue that affect Canadians as well. Actually, our healthcare system came about as a result of one of the provinces funding the necessary facilities to encourage better doctor coverage in rural areas especially. Given the nature of quality healthcare and its standards, having enough qualified doctors is a challenge that I think will never go away. I think it's more about how its managed.

    I was affected by the shortage when I moved from my smaller hometown to Toronto. I was going to university at the time, and I didn't take the time to find a family doctor, so I instead visited walk-in clinics. It was good timing, because I was younger, in good health, don't have any dependants, and didn't require doctors that much. I know I'm a rarity, so I do sympathize with those who can't find a family doctor.

    Several years later, I lucked out and found out about a doctor close by who recently started practicing. (I used the province's college of physicians' search engine.) It's a great match. He's male, about the same age as me, and very thorough. I did have a few false starts before him, including one doctor who was this homeopathic practitioner in addition to practicing family medicine. She was going to get me to do something that I felt was pretty useless, so I didn't return. That's the kind of thing you run into when the pickings are slim, unfortunately.

    Now I have to deal with a busy, busy doctor. Usually when I book an appointment, it's at least a couple of weeks in advance, if not three.

    At this point, I'll take it. There are still walk-in clinics, and my doctor belongs to a network of them, where they share services and medical information. I haven't used it yet, but I assume it's better than what I've done for years: gone to random clinics with random doctors.

    I'm not sure if you mean my personal solution, or my solution to the greater problem. For my personal solution, see above.

    My wider solution is reform regarding how we handle immigrants who have medical degrees and especially who have medical licenses and experience in other parts of the world. Currently, Canada is very protective of its standards of practices, education, and licensing, so you end up being driven home from the clubs in the wee hours in the backseat of a cab driven by what could very well be a highly talented, highly trained doctor from Pakistan. The guy's lucky to be making minimum wage too, and he has to listen to your drunken pontificating.

    These folks need to be retrained, tested, supplementally educated, something. Because it's a goddamn waste, considering we need more goddamn doctors.

    I'm not sure if there is this same issue in the U.S., just as I'm not sure if there is the same too-many-grads/not-enough-residencies issue in Canada. But a shortage is a shortage, no?

    A stock answer here in Canada is, heh, encourage the private sector to get more involved. (This may seem topsy-turvy to you, and rightly so.) Many support a two-tier system, where the private sector is allowed to "pick up the slack" for the public system. I'm not sure if this works as it should across the board. I think for it to work it would have to be closely regulated. By this I mean that the system should not be let to corrupt under creeping privatization, especially to the extent where poor people get slow, suboptimal care while the well-to-do get fast, top-quality care because they can subsidize it (in other words, the public is still picking up much of the tab).

    As for residency shortages in what I assume to be a much more broadly private (either profit or non-profit) health system (i.e., the U.S. system vs. Canada's), I think it would make sense to use public funding to open up more spots. I mean, what could be better for the public good than having enough doctors?

    I'm under the impression that public hospitals are in decline: Public hospitals decline swiftly - Washington Times

    That's a big part of the problem, don't you think?
     
    Last edited: Nov 5, 2013
  3. redux

    redux Very Tilted

    Location:
    Foggy Bottom
    The linked Forbes article hits at the heart of the problem - Medicare funds more than 75% of all residencies (at a cost of approx. $150,000 each) and the number of federally funded residencies has been capped for 15 years.

    A bi-partisan bill introduced this year addresses residency funding and the larger issue of a shortage of physicians:
    Beyond Medicare funding, teaching hospitals fund most of the rest through clinical fees, competing with numerous other hospital priorities.

    In the light of the current budget/debt reduction battle, is it worth the bill's $9 billion (over 5 years) in new funding?

    In the short term, I dont have a better solution.
     
  4. fflowley

    fflowley Don't just do something, stand there!

    Gg, I'm curious what specialties your friends are applying to. Are we talking highly selective programs like Dermatology, or more common positions like Internal medicine or Family Practice?

    One other way to address the coming physician shortage (I say coming but it sounds like in some places it's arrived already) is to make the work less onerous for seasoned physicians and keep them practicing longer. The introduction of electronic medical records has already ended many a medical career. Physicians in their 50's and over, still highly productive but well enough off to be able to retire prematurely if they desire, are leaving in droves. They never had to deal with computers and the resulting complications in care, and they weren't raised using them so they can't pick up the skills easily. Add to that rigid, jam packed scheduling with management focused on revenues in the practice and you force people out.
     
  5. snowy

    snowy so kawaii Staff Member

    My local hospital has actually expanded its residency program. We have a clinic here that uses residents for family care. It's an excellent clinic. Because it staffs med students doing clinicals and a variety of residents, it's not uncommon to get really comprehensive, careful care. All of the care is overseen by an attending. For example, when I went in last spring to get my knees checked, I got not one, but FOUR knee exams because the med student had to practice on me after the resident demonstrated the exam.

    What helps is our hospital has engaged in a strategic partnership with a medical school out of Southern California to open a branch campus here. Their goal was to address a chronic doctor shortage in our area. It's going to take a while for it to help, but the resident clinic is a nice benefit. It's easy to get an appointment, and they all seem very skilled.
     
  6. ASU2003

    ASU2003 Very Tilted

    Location:
    Where ever I roam
    It hasn't.

    Shared medical appointments streamline doctor's visits | TIME.com

    This was an article I read a few months ago that came up with a new way for doctors to see more patients and get more information to the patients. But, there will be other people who also are having your symptoms there. My first reaction was "hell no", but then I started to think about it, and for a few conditions, I wouldn't care and it would work better if they could see multiple people at once. Plus, it would save the doctor from having to repeat the same thing over and over again.

    The AMA shouldn't be managing this like a new car manufacturer. At least I hope they aren't holding back potential doctors so the current ones will be able to charge more and have less competition.

    I would also like to see some ultra-specialized practices come to the medical field. If you need a knee replaced, you go to the doctor that only does knees. Their entire schooling was based around learning that and the newest and best practices, yet still learn the information that hasn't changed extremely well.
     
  7. fflowley

    fflowley Don't just do something, stand there!


    You will find super-specialized physicians practicing this way in every city and most suburbs of America.
    When you get a post-op complication you better pray that the good old fashioned internist is available though.
     
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