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Topic: How to Solve a Shortage of Doctors in Just 12 Months. Affordably. (Read 915 times) |
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Hermit
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How to Solve a Shortage of Doctors in Just 12 Months. Affordably.
« on: 2009-04-27 04:15:23 » |
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Shortage of Doctors Proves Obstacle to Obama Goals
[ Hermit : There is a shortage of doctors(and nurses) in the US. It is true. It is also deliberate. By and large, doctors from elsewhere in the world cannot obtain a visa to enter the US to work as a doctor unless they have a scarce speciality. The medical community in the US, which is indubitably the most expensive, even though it is far from the best available, prefers it to be this way, as it keeps the prices comfortably high for doing far less work than doctors in other countries (who still, for one example, make "house calls" in many countries for amounts most people can afford). So they lobby really hard to maintain an abatis about the US, largely impregnable to foreign trained medical personnel. It follows that if anyone is really serious about addressing the shortage, all that is needed to address the shortages is to demolish the rubbish intended to prevent foreign staff from molesting the profitability of American suppliers. This might best be approached by offering anybody interested, holding a medical credential from another country, a visa valid for 1 year to the US, and a loan sufficient to pay for the 6 months or so that board qualification should take. Applicants would have to pass US medical board examinations (which are stiff) and prove competency in a needed language, English, Russian and Spanish being some languages with proven needs, before changing their visa status. Those dropping out would need to repay the loan before becoming eligible to re-enter the US. Those passing the boards and proficiency tests would be issued a 4 year visa, conditional on them working for the National Health Service Corps in any location required of them, at some reasonable rate (e.g. the same pay as a US worker would currently receive). After four years, the medical worker would be eligible for an unrestricted green card and could work for anybody. The queue of highly qualified people heading here would introduce new thinking and healthy competition into the medical field, would be of huge benefit to the ageing population, and would not harm anyone to any significant extent. Except perhaps, for those selling memberships in expensive clubs and other high value toys to the medical profession.
Combine the above with true government backed insurance, that doesn't run out of benefits just as the need becomes greatest, which is what normal health insurance does, and add the proviso that the beneficiary has to pay up to some percentage of household income themselves before they become eligible for state aid up to some limit of household income multiplied by the prognosis and life expectancy and you have a winning formula to control costs and ensure true universal health care in the USA. ]
Source: NY Times
Authors: ROBERT PEAR
Dated: 2009-04-26
Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
Some of the proposed solutions, while advancing one of President Obama’s goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care but could make it more difficult to rein in costs.
The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.
Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada.
Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”
Even people with insurance have problems finding doctors.
Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.”
To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods. [ Hermit : Not serious! ]
Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease.
“Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system. [ Hermit : Not serious! The song of the lobbyist.]
The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists. [ Hermit : Not serious! More lobbyists.]
Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way.
“If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”
The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year.
“If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older,” said Dr. Atul Grover, the chief lobbyist for the association. “Let’s say we insure everyone. What next? We won’t be able to take care of all those people overnight.” [ Hermit : Not serious! More lobbyists.]
The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.
“Some of the newly insured patients still rely on hospital emergency rooms for non emergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.
The ratio of primary care doctors to population is higher in Massachusetts than in other states.
Increasing the supply of doctors could have major implications for health costs.
“It’s completely reasonable to say that adding more physicians to the work force is likely to increase health spending,” Dr. Grover said. [ Hermit : Only if it is done very stupidly. Economics teaches the opposite unless the market is being manipulated. Then again, I can't think of any market outside prisons and military suppliers more manipulated than medicine. Fix that and the costs will fix themselves.]
But he said: “We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary.”
In many parts of the country, specialists are also in short supply.
Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.
“It’s a long, exhausting drive, three hours down and three hours back,” Ms. Schuster said.
The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.
The Obama administration is pouring hundreds of millions of dollars into community health centers.
But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.
Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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letheomaniac
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Re:How to Solve a Shortage of Doctors in Just 12 Months. Affordably.
« Reply #1 on: 2009-04-28 03:57:11 » |
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[letheomaniac] In South Africa we too suffer from a major shortage of qualified doctors and nurses. This is not because these are unpopular courses of study and while it is fairly expensive to attain a medical degree, the larger portion of this expense is borne by the South African government. Once qualified, doctors are required to be residents in a government hospital for a number of years in an attempt to recoup some of the money spent on training them. Once they have completed their residency, huge numbers of South Africa's new-minted doctors are poached by other countries that offer them salaries in pound or dollars and eye-popping benefits, similar in fact to the way that the tiny oil-states of the Gulf recruit their athletes. The same of course goes for our nurses.
Hermit:
Quote:| This might best be approached by offering anybody interested, holding a medical credential from another country, a visa valid for 1 year to the US, and a loan sufficient to pay for the 6 months or so that board qualification should take. Applicants would have to pass US medical board examinations (which are stiff) and prove competency in a needed language, English, Russian and Spanish being some languages with proven needs, before changing their visa status. Those dropping out would need to repay the loan before becoming eligible to re-enter the US. Those passing the boards and proficiency tests would be issued a 4 year visa, conditional on them working for the National Health Service Corps in any location required of them, at some reasonable rate (e.g. the same pay as a US worker would currently receive). After four years, the medical worker would be eligible for an unrestricted green card and could work for anybody |
[letheomaniac] I think that the third world has enough of a brain-drain problem already and flinging open the borders of the United States to South African doctors and nurses and others from countries in a similar situation, particularly while dangling a shiny Green Card in front of them, would be somewhat unfair to the sick people in these people's home nations. There would be a stampede of medical professionals leaving Africa and other needy parts of the globe for the US. The American population may be ageing, but in large parts of the world people are still dying young from preventable diseases. Therefore, if one were to institute legislation allowing doctors and nurses from other parts of the globe to be imported to cover the shortfall within the United States, I think that there would have to be very definite guidelines as to where these medical professionals may be imported from. I would rule out most of the developing/third world. This of course presents another problem which is that developed/first world countries are by and large already net importers of doctors and nurses themselves and are probably going to be unwilling to part with any of them. This leaves us with my solution to the problem - the US should suddenly become very friendly with the Cubans. They have plenty of doctors and after being on the receiving end of the US trade embargo for so long I'm sure that there are plenty of things that they don't have that they wouldn't mind trading a few good Cuban doctors for. Add some spin and voila! Diplomacy souffle!
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Hermit
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Re:How to Solve a Shortage of Doctors in Just 12 Months. Affordably.
« Reply #2 on: 2009-04-28 05:43:57 » |
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The plight of the Cuban doctors was in the forefront of my mind when I wrote this.
I did consider the factor you mention, but I think you may have it the wrong way around. The reality is that many people coming to the US will find it far too oppressive here for their taste, and will return to their origin, taking large amounts of valuable knowledge and training with them. Certainly I have many friends in the medical profession who have done exactly this, some of them more than once, and know some specialists who still work a few months a year in the US replenishing their finances but provide free or subsidized care - and live - elsewhere. More significantly, many countries are good at producing large numbers of medical personnel cost effectively. South Africa, Israel, France, India, Pakistan, the Ukraine and Cuba in particular, come to mind.
If the proposed strategy were adopted, as demand picks up, young people around the world will (rightly) perceive it as an opportunity, and supply will soar; as a few years in the US will not only pay for a medical education, but will set participants up with funds to enter practice for themselves. So I think that the suggested strategy will result in more personnel being available globally, not just in the USA, in a fairly shot period of time.
The other half of this equation is that should humanity somehow beat the odds, thread the needle and survive the next two decades, I think that AI diagnosis, quasi independent surgical robotics, telemedicine procedures, custom production of individually targeted drugs, autovacinations and stem cell techniques are all going to revolutionise medicine and its availability, through necessity if not industry choice. Which might make the suggested technique obsolete, but between now and then we need solutions.
What is being offered in articles such as the one I quoted are not solutions, but, like the problems in banking, finance and the military, more of the same, incapable of changing anything except for the worse, proposed by those responsible for the debacles we face around the world. So far I haven't seen anything that approaches my proposal in simplicity, effectiveness or cost efficiency.
Kindest Regards
Hermit&Co
PS The following threads may be of interest:
Church of Virus BBS,General, Science & Technology, Socialized Medicine?
Church of Virus BBS, Mailing List, Virus 2006, Fidel, Raul and a bucket
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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letheomaniac
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Re:How to Solve a Shortage of Doctors in Just 12 Months. Affordably.
« Reply #3 on: 2009-04-29 03:54:20 » |
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[letheomaniac] Thanks for the BBS links - interesting...
[Hermit:
Quote:| The plight of the Cuban doctors was in the forefront of my mind when I wrote this. |
[letheomaniac] According to an article I was just reading, they make about $20 a month. I'm sure that's a lousy wage even if you do live in a socialist society.
Hermit:
Quote:| I did consider the factor you mention, but I think you may have it the wrong way around. |
[letheomaniac] It is entirely possible that I do. I think that perhaps the South African press tends to exaggerate the brain drain problem. The 'National Skills Shortage' (it's become such a fixture that it deserves capitals) has become part of our national memeplex. Perhaps we should stop complaining and just hire some Zimbabweans.
Hermit:
Quote:| ...AI diagnosis, quasi independent surgical robotics, telemedicine procedures, custom production of individually targeted drugs, autovacinations and stem cell techniques are all going to revolutionise medicine and its availability, through necessity if not industry choice. |
[letheomaniac] And nanotech! Check this out:
Source: http://www.commodityonline.com
Author: Not credited (Commodity Online)
Dated: 28/4/2009
Gold helps scientists make artificial nose
MUNICH: Want a golden artificial nose? Soon, your desire may come true! Scientists have used nanotechnology to take a step closer to the production of artificial noses.
According to reports, researchers at LMU Munich have employed the technology, which often involves the use of gold, in order to develop nano-eletromechanical systems (NEMS) that feature minute strings that resonate when a molecule comes into contact with them.
These strings can then be produced on a chip that could detect various molecules such as pollutants at a very sensitive level.
Ideally, you would have several thousand strings sitting on a chip the size of a fingernail, each one for highly specifically recognising a single molecule.
If a molecule docks onto one of the strings, then it becomes heavier, and its oscillations become measurably slower. Until recently, however, such nano-electromechanical systems have been short of practical applications.
Physicists at LMU Munich have now made a breakthrough in this field: They have constructed a system of nanostrings made of non-conducting material, where each string can be electrically excited separately. One of the devices that could be created with this system is a highly sensitive artificial nose that detects various molecules individually. These new NEMS could also be used in a multitude of other applications – acting as tiny pulse generators in mobile phone clocks, for example.
Quick, certain and cheap detection of single molecules is a task that chemical analysts are now expected to perform.
There is a method they can employ for this, which uses nanotechnology: Specifically, they use “nano-electromechanical systems”, or NEMS. These systems involve strings with diameters of the order of 100 nanometers – a ten-thousandth of a millimeter or a 1/500 of a human hair – which can be excited to resonate in a characteristic fashion. If these strings are coated with the right kind of chemicals, then molecules will dock onto them.
More specifically: only one kind of molecule can dock onto each string. When a molecule docks onto a string, the string becomes heavier and its oscillation slows down a tiny bit.
By measuring the period of oscillation, chemical substances can be detected with molecular precision .
Until recently, however, getting such systems to work has proven technically difficult; one problem being to produce and measure the oscillations. While the nanostrings can be made to oscillate by magnetomechanical, piezoelectric or electrothermal excitement, this only works if the nanostrings are made of metal, or are at least metal-coated, which in turn greatly dampens the oscillations, preventing sensitive measurement. That hardly allows the detection of a single molecule. It also makes it harder to distinguish the different signals from differently oscillating strings.
The newly developed method now avoids these difficulties. Quirin Unterreithmeier, Dr. Eva Weig and Professor Jörg Kotthaus of the Center for NanoScience (CeNS), the faculty of physics of LMU Munich and the cluster of excellence Nanosystems Initiative Munich (NIM) have constructed an NEMS in which the nanostrings are excited individually by dielectric interaction – the same phenomenon that makes hair stand on end in winter.
Following this physical principle, the nanostrings, which are made of electrically non-conducting silicon nitride, are excited to resonate when exposed to an oscillating inhomogeneous electric field, and their vibration then measured.
The alternating electric field required for this stimulation was produced between two gold electrodes right up close to the string. The oscillations were measured by two other electrodes. “We created this setup using etching techniques,” reports Weig. “But this was easily done – even repeated ten thousand times on a chip. The only thing to do now is to make sure the strings can be individually addressed by a suitable circuit.” All in all, this ought to be a technically easy exercise – but one that will allow a breakthrough in chemical analysis. Yet there are even more applications that can be seen beyond this “artificial nose”. Among other things, the nanostrings could be employed as the pulse generators in mobile phone clocks, for example. These novel resonators could even be used as ultra-sharp electrical signal filters in metrological systems.
[letheomaniac] Time to retire the bloodhounds?
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"You can't teach an old dogma new tricks." - Dorothy Parker
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