We don't need more doctors(cnn.com)
cnn.com
We don't need more doctors
http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html
6 comments
"90% of the time when you go to the doctor, you just need the sanity check and the antibiotics."
Actually, most of the time the patient just needs the sanity check and a prescription for something to alleviate the symptoms of their condition (i.e. a cough suppressant) enough for them to be able to get a decent night's sleep so their body can heal itself. Antibiotics are way overprescribed. Most of the time you don't need them.
Actually, most of the time the patient just needs the sanity check and a prescription for something to alleviate the symptoms of their condition (i.e. a cough suppressant) enough for them to be able to get a decent night's sleep so their body can heal itself. Antibiotics are way overprescribed. Most of the time you don't need them.
Antibiotics are often used as a placebo, since doctors can't prescribe placebos. :)
"90% of the time when you go to the doctor, you just need the sanity check and the antibiotics."
Sure, but what about the remaining 10%? Even "proper" doctors often mess up the diagnosis - would the nurses do so much better?
Actually I wonder about the antibiotics, too. Wouldn't the need for antibiotics already signify a serious condition? I know there is the tendency to just prescribe them for everything (even virus diseases), but maybe that is just bad doctors? I don't think it makes sense to say "we don't need more doctors, because doctors are bad anyway", so I think we would still be stuck with "we need more good doctors".
Sure, but what about the remaining 10%? Even "proper" doctors often mess up the diagnosis - would the nurses do so much better?
Actually I wonder about the antibiotics, too. Wouldn't the need for antibiotics already signify a serious condition? I know there is the tendency to just prescribe them for everything (even virus diseases), but maybe that is just bad doctors? I don't think it makes sense to say "we don't need more doctors, because doctors are bad anyway", so I think we would still be stuck with "we need more good doctors".
They don't have to do much better; they escalate to doctors. Nobody's arguing that NP's should be performing appendectomies.
I understand that idea, I am just worried about the cases where the nurses fail to recognize a serious condition. Of course that could happen to a doctor, too, but overall, I imagine it to be a very upsetting situation if you really feel like you want to see a doctor, but your way is blocked by a nurse.
What does the market say anyway? Do people want cheap nurses as an alternative to doctors? If so, I guess it would be fine, just let people choose where they want to go. But that is not necessarily what is happening. For example in Germany (very different system probably), the insurance company makes the rules about the kind of treatments they allow you.
What does the market say anyway? Do people want cheap nurses as an alternative to doctors? If so, I guess it would be fine, just let people choose where they want to go. But that is not necessarily what is happening. For example in Germany (very different system probably), the insurance company makes the rules about the kind of treatments they allow you.
All you need to do is give the nurses broad escalation criteria. Anything that doesn't perfectly fit the symptoms of the easy diseases gets escalated.
Incidentally the few states where they are legal, the nurse clinics do very well.
Incidentally the few states where they are legal, the nurse clinics do very well.
I have been formulating the opinion that we need more doctors. Most doctors will tell you they work too many hours. This can't be good for anyone. The only thing it does is allow them to make more money. Many need that cash: pay off loans, ROI for all their training etc..
What would happen if doctors only worked a 4 day, 40 hour work week? We would obviously need more doctors to make up the shortfall. There would be costs associated with that, but once we doubled the number of doctors, there may be some great financial and quality benefits for all parties. The only downside is most doctors would make less, but they would have still be upper-middle class and have a very comfortable life.
What would happen if doctors only worked a 4 day, 40 hour work week? We would obviously need more doctors to make up the shortfall. There would be costs associated with that, but once we doubled the number of doctors, there may be some great financial and quality benefits for all parties. The only downside is most doctors would make less, but they would have still be upper-middle class and have a very comfortable life.
I'm not sure I agree with all of your assessment.
The doctors that make all the money do it in private practice, and they also arent the ones who are generally over worked.
Some specialties make more money than others, and those specialties attract doctors who value money. However, working for public hospitals in many places, or some specialties, you know you are working with people who do not value money (at least not as a primary motivator).
Remember -- the doctors who make the real money in medicine do it becuase they own their practice. This is just like working as an electrician or owning your own electrician company that employees 10 people. Owners make more.
The doctors that make all the money do it in private practice, and they also arent the ones who are generally over worked.
Some specialties make more money than others, and those specialties attract doctors who value money. However, working for public hospitals in many places, or some specialties, you know you are working with people who do not value money (at least not as a primary motivator).
Remember -- the doctors who make the real money in medicine do it becuase they own their practice. This is just like working as an electrician or owning your own electrician company that employees 10 people. Owners make more.
Clayton Christenson's book, The Innovator's Prescription, is very good. It outlines the processes of business disruption that are beginning to affect the health care industry status quo, including these quick medical clinics against the GPs, enhanced diagnosis tools for GPs disrupting specialists, and the rise of narrowly focused, high throughput specialty institutes that focus on one type or genre of operation and do it extremely well (using principles adopted from the Toyota Production System).
A recommended read for anyone interested in the future of the industry.
A recommended read for anyone interested in the future of the industry.
But we need to move away from the "guild" mentality that has kept boundaries narrow and created regulatory, licensing and reimbursement obstacles to new models of health care delivery.
Fair enough, and some of his ideas seem good, but the "guild mentality" is precisely what's keeping the supply of doctors down. There are regulatory burdens on both sides of the equation, and I don't think it's entirely clear which way things would move if they were relaxed.
Fair enough, and some of his ideas seem good, but the "guild mentality" is precisely what's keeping the supply of doctors down. There are regulatory burdens on both sides of the equation, and I don't think it's entirely clear which way things would move if they were relaxed.
It's so hard to get good information on this issue because so many of the people we get our information from are themselves key stakeholders in the process. Of course the general public wants more doctors. That would generally mean lower prices, lower waiting times, etc. And of course the AMA will insist we don't need more doctors.
The article isn't exactly an AMA shill insisting we don't need more doctors. Rather, it's a guy pointing out that we have a shortage of medical services, and suggesting that non-doctors (e.g. nurse practitioners) can provide some of them.
"Rather than calling for more doctors, which would have been difficult for the government to impact anyway, what the country really needs are policies that pave the way to more avenues of care, which is well within the government's control."
"Rather than calling for more doctors, which would have been difficult for the government to impact anyway, what the country really needs are policies that pave the way to more avenues of care, which is well within the government's control."
The issues are related, though. Non-doctors are banned from performing certain medical services, and the supply of doctors is restricted.
You should re-read the article; it argues that we should attack scarcity directly, by removing doctors from the picture.
Ah, okay. But I was getting at the doctors' reaction to this proposal. Judging by a few of the comments on the article, doctors don't agree with that proposal. But is it because they're concerned for their patients' well-being, or because they're concerned about the possible loss of income? Both are plausible reasons, but they each invite different counter-arguments. How are we supposed to know why the doctors oppose this, and how credibly should we take their argument?
Some of the commentary at the bottom of the link is good.
This doesn't seem like a minor thing:
* You don't need to have a relationship with a clinic to drop in. Changing or losing insurance doesn't change the clinics you can visit.
* Clinics are much faster than doctors offices.
* Clinics are much more flexible than doctors offices (again: you just drop in).
* Clinics are much, much cheaper than doctor's offices.
It's been said that a big part of our health care problem (after things like geriatric care) is that front-line services are being provided by hospitals to people with acute conditions, without insurance, who haven't had access to preventitive care. This sounds like a concrete step towards fixing that.