Doctor shortage? If there is, it won’t be because of malpractice insurance
Friday, June 11, 2010
A recent article by Tammy Worth in the Los Angeles Times devotes more than 1,200 words to “the coming doctor shortage.” It’s interesting to note that none of those words are “malpractice” or “insurance.” Advocates of restricting medical negligence victims’ rights to receive compensation for their injuries would have you think the cost of malpractice insurance is causing doctors to get out of the business and prompting potential doctors to choose other fields.
The root of the doctor shortage seems to be money, all right, but the concern is income, not expenses.
But first, the projected shortage. The Association of American Medical Colleges (AAMC) issued a report last year estimating there will be “a shortage of 124,000-159,000 physicians by 2025,” with the caveat that the adoption of universal health care could add 25 percent to that number. The American Academy of Family Physicians suggests a similar shortage, just in primary care family doctors. Neither of those organizations mentions the cost of malpractice insurance in its analysis.
Some of the reasons for the doctor shortage are demographic. Not only does the U.S. Census Bureau project the population to grow by more than 60 million over the next 20 years, the number of people 65 and older is expected to nearly double. Dr. Atul Grover, chief advocacy officer for the AAMC, told Worth the amount of medical services required by people over 65 is “two to three times higher than many other adults.”
But Worth adds there is another reason for the projected doctor shortage.
A physician providing a 30-minute office visit is reimbursed $103.42 by Medicare, while a diagnostic colonoscopy — which takes about the same amount of time — nets $449.44, according to Bruce Steinwald, director of healthcare for the Government Accountability Office, in testimony he gave to the Senate Committee on Health, Education, Labor and Pensions in 2008.
A pediatric ophthalmologist makes half the income of one working with adults, Phillips said. And if a medical student chooses to go into primary care instead of a subspecialty like cardiology, which pays more, they will lose $3.5 million in income over a lifetime, he added.
“A lot of people want to go into primary care, but they can’t make the math work,” he said. “You really have to have a passion for primary care to choose it.”
Granted, primary care doctors typically make $150,000 to $200,000 a year, according to Kevin Barnett of the Public Health Institute as quoted by Worth. To most of us, that sounds like a lot of money. But we understand why anybody would want to earn as much as their skills allow, so we don’t begrudge doctors who choose to go into higher-paying areas.
But is there really a looming doctor shortage? For one thing, during his Congressional committee testimony in 2008, Steinwald testified the number of primary care physicians had grown faster than the population in recent years, with the number of physician assistants and nurse practitioners (also involved in primary care) growing faster yet. And there’s this from Tammy Worth’s report:
“I don’t think there is an overall doctor shortage, and I don’t think we are facing one,” said Dr. David Goodman, director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “At any point in time, there are relative surpluses and shortages of physicians by specialty and place, but the loudest banging of the doctor shortage drum has been done by teaching hospitals looking for more money to expand training.”
Hmmm…another connection between the doctor shortage and money.
Bottom line: if you hear proponents of so-called tort “reform” say malpractice insurance premiums are reducing Americans’ access to health care, you’ll know that apparently no one who is studying the issue agrees.