Episode 95 Recap – Is the Mainstream media finally seeing the physician shortage?

The Print version of the FLATLINING Podcast

In this episode, Matthew and Ron discuss the looming American physician shortage and its wide-ranging impact. Matthew noted that a recent PBS story addressed the drop in pediatric physicians. He asked Ron if this was a positive sign that PBS was covering the physician shortage issue. Ron said it is a good sign that we are now seeing it, but asked rhetorically if it was “too late.”  He said, “Identifying this problem is great, but fixing this problem is not an easy thing or a quick thing, given how long it takes to train doctors.”

Matthew noted that in the story, the pediatric specialty problem seemed to come to light when the issue affected them. He said the story highlighted parents struggling to get appointments for routine physicals and specialty care. Sometimes they waited months and in one case over a year in advance, he said.  Ron agreed saying that often something like this is a theoretical problem until it affects you, he said. Ron pointed out that they have discussed this topic a lot on the podcast and stressed that we can’t just wait to problem is personal. He said this problem is affecting multiple specialties, and the statistics are “scary”.

Ron described a recent survey of physicians that asked if they would recommend to their children that they enter medicine. He said two-thirds of physicians said they would not recommend the medical profession to their kids. Ron said that is troubling, noting that becoming a doctor used to be one of the things parents were most proud of.  There is a projection, he said, that by 2036 we will be 86 thousand physicians short. Ron said that the problem goes deeper because the combination of all medical schools in the U.S. graduate just under 30 thousand physicians a year. He pointed out that it would take three years to catch up to this shortage if no other physicians left the practice of medicine, and the population did not grow. Ron shared one other alarming report that said 25 percent of students in medical school or nursing school are considering quitting. The other disturbing statistic he said was that 61 percent of students in nursing or medical school are not going to use their degrees for direct patient care. Rather they would work for insurance or pharmaceutical companies or some other business, Ron said. Put all these factors together and it will take much longer than three years to solve the shortage problem, he said.

Matthew pointed to one of the solutions the team at Fulcrum Strategies is familiar with and was highlighted in the PBS story, the reimbursement rate for physicians. He noted that pediatricians often see a mix of patients who are on commercial insurance and government insurance, generally Medicaid. According to Ron, Medicaid in most states reimburses at a lower rate than Medicare, and Medicare is lower than commercial insurance and is often the target of Congressional budget cuts, he said. Additionally, Medicaid rates often track with Medicare, so when you read about Medicare cuts, you will also see cuts to Medicaid reimbursement, he said.

This all becomes problematic for new pediatricians after years of training and entering the workforce later in life and carrying $200,000 to $300,000 in debt, he said. Ron continued, “It’s no wonder that almost two-thirds of folks in training are saying ‘I am not going to practice medicine, I will never dig myself out of this hole that I got,  I got to do something else that pays better.’”   

Matthew asked Ron, what else besides raising Medicare/Medicaid rates, which would likely raise our taxes, could be done to address the shortage problem. Ron said that the money part is one piece of the puzzle, but most physicians did not go into medicine strictly for the money, physicians talk a lot about their “passion” for medicine and wanting to “help people.”  Ron said the first thing to do is return “respect” to the profession.

He said this is done by “getting the insurance companies out of their exam room and telling them how to practice medicine.” It’s all the “hassle-factor” stuff of endless paperwork and “mother-may-I?” requirements that insurance companies burden the physician with that don’t have anything to do with delivering the best care. He said the other factor is the financial, the message that is sent from Congress every year by lowering the Medicare/Medicaid reimbursement rates is demoralizing. He said, “You can’t expect someone who gets many times half of their money from federal funding, Medicare/Medicaid, to feel good about it when every year the message you send them is ‘You are overpaid and deserve a pay cut’ because when you cut the reimbursement that is what you are saying.”  Ron pointed out that recipients of Social Security get a cost-of-living adjustment every year, but Medicare reimbursements don’t. Nothing against seniors, he said, but pointed this out for a comparison.  

Lastly, we as a society need to improve our respect for the physician and what they are doing, he said. He pointed out the frustrations he has heard from physicians dealing with ill-informed patients either arguing over vaccinations or some other treatment that shows no clinical value. It’s not that we have to look at them as God, he said, but let us as patients respect what they bring to the table in their care of us or one day they may not be there, he said.  

Matthew pointed out the diverse political leanings of physicians as a voting block and pondered if a solution might be that they decide to stop seeing new Medicare/Medicaid patients, and asked Ron if this could solve the problem. Ron said it could, but that he did not think physicians would want to do that and harm patients. Additionally, he said, opponents would point to them and possibly say, “They are holding seniors hostage” and be painted out to be the bad guy. Ron said he is not pro or con union, but said imagine if all physicians formed a single union and they decided after another Medicare cut to have a one-month walkout on Medicare/Medicaid patients. That might bring the point home to legislators he said.  Or they could decide not to have a contract with Medicare, for example, he said. Ron said he is not advocating that, but “If we don’t solve this problem in a way that maintains the profession, it will solve itself.” There just won’t be access, he said, and as a country, we are not used to that and won’t like it.

Ron closed by encouraging us to be sure to thank our physicians and medical staff for what they do, we often thank servicemembers and rightly so, he said, but thanking your physician for their care of you will go a long way to encouraging them in their care of the rest of us.