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January 2, 2013

Hey, as long as we’re highlighting all the wonderful things that the last four years of politics have done for us so far, let’s not forget our new health care system.  Rife with unintended consequences, it’s going to create problems by requiring a focus on the wrong kind of doctor… the one that nobody can afford to be…  From the Chronicle:

Even without the Affordable Care Act, a worsening doctor shortage had been forecast as the state’s and nation’s population ages and grows, and as a generation of older doctors retires. But by mandating that individuals have insurance and expanding Medicaid, the law will extend coverage to an additional 30 million Americans and place a greater strain on the physician workforce, especially for primary care.

“Now with the Affordable Care Act, we’re going to have an even greater need,” said state Sen. Ed Hernandez, D-West Covina (Los Angeles County), chairman of the Senate Health Committee. The need for more primary care doctors is addressed in the federal health law through various financial incentives, and California’s medical schools and hospitals are putting a greater emphasis on primary care training and expanding residency programs. But the effects of such efforts may not be felt for years.

A report cited in the article says that over 30% of California’s current doctors are older that 60… that is, right at that age where they’ll be thinking retirement looks a lot better than increased workloads, more e-mail, and a ton of other crud that’s thrust upon them.  I’m guessing this is going to take two directions: The first will be pushing people away from actually seeing a doctor in the first place, by adding to the burden of pharmacists, etc.  So the first solution for anything will be a pill or a quick-fix remedy as opposed to a study of the cause.  The second will be pushing a new round of educational initiatives to get us a bunch of doctors in ten years.

Let’s look at that second one.  The push for STEM in education is already pretty awful, though there are always bright spots.  So we’re likely looking at an influx of foreign students into our shiny new med schools to keep up with the demand.  Oh, and let’s not forget one of my other favorite comments about college these days:

Kendra Johnson, a fourth-year UCSF medical student, estimated she will be $160,000 in debt when she graduates and called the fact that specialists make more “the elephant in the room” for her and her classmates who hope to enter primary care residencies.

So to pay off a load like that, a doctor will likely need to find a specialty as opposed to standard primary care.  Let’s not forget that primary care doctors have one of the higher malpractice insurance premiums given the raft of patients they have to see.  I expect that a need for primary care will push premiums even higher for people to actually see them, since we’ll need to make the field more attractive.  So how is that health care bill at reducing costs?

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