

We don't need more doctors - aswanson
http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html

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tptacek
Have any of you been to a nurse-practitioner-managed clinic? We have. 90% of
the time when you go to the doctor, you just need the sanity check and the
antibiotics. For those cases, the clinic totally beats the doctor's office.

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.

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blahblahblah
"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.

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mrkurt
Antibiotics are often used as a placebo, since doctors can't prescribe
placebos. :)

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jhancock
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.

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Brushfire
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.

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mediaman
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.

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epe
_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.

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aneesh
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.

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yummyfajitas
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."

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johnnybgoode
The issues are related, though. Non-doctors are banned from performing certain
medical services, and the supply of doctors is restricted.

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aswanson
Some of the commentary at the bottom of the link is good.

