Physician shortage is a huge myth and we *don't* need more residencies or midlevels

[MedicineZ0Z]

If anything we have too many residencies and far farrr too many midlevels (if you look job apps:jobs ratio).
We also have a lot of residencies providing subpar or bad training. This is due to: lack of patient volume and pathology, inadequate staff and lack of resources. There are only so many complex patients to go around and only so many physicians who are good educators (most are not).
In addition, we have an oversupply of doctors in desirable areas of the country.

Just putting this out there because a lot of people seem to be drinking the shortage kool aid. There is none. There is certainly a distribution issue when it comes to rural areas but even that is exaggerated in 2019. But "shortages" are fabricated in order to increase supply to drive down salaries.

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[Lucca]

No mention of AI, 0/10

 

[sella.turcica]

If anything we have too many residencies and far farrr too many midlevels (if you look job apps:jobs ratio).
We also have a lot of residencies providing subpar or bad training. This is due to: lack of patient volume and pathology, inadequate staff and lack of resources. There are only so many complex patients to go around and only so many physicians who are good educators (most are not).
In addition, we have an oversupply of doctors in desirable areas of the country.

Just putting this out there because a lot of people seem to be drinking the shortage kool aid. There is none. There is certainly a distribution issue when it comes to rural areas but even that is exaggerated in 2019. But "shortages" are fabricated in order to increase supply to drive down salaries.

Any reference or stats?

 

[CidHighwind]

If we have too many doctors, why are the wait times for so many doctors months and months out?

 

[Goro]

Can you show us where the midlevel hurt you?

 

[VA Hopeful Dr]

If we have too many doctors, why are the wait times for so many doctors months and months out?

We definitely don't have too many doctors, but I'm not sure we're actually in a terribly dire shortage situation either.

Part of it is a distribution issue. There's a reason lots of folks can't find jobs and the more popular major cities.

Part of it is poor utilization. Our endocrinologist are booked out quite a ways, but I've definitely seen quite a few patients with metformin monotherapy controlled diabetes who insist on seeing endocrinology despite the fact that any primary care physician could manage that with no problem.

 

[sella.turcica]

Can you show us where the midlevel hurt you?

Please don't.

 

[Ho0v-man]

No mention of AI, 0/10

Plot twist: OP is actually sentient AI and this is the first step in its attempt to increase its own demand by worsening the physician shortage.

 

[MedicineZ0Z]

If we have too many doctors, why are the wait times for so many doctors months and months out?

Who has a very long wait time?

 

[tri99]

Who has a very long wait time?

Current wait time for a general physical in my clinic located in research triangle (Raleigh /Durham/ Chapel hill) is ~13 weeks

 

[ndafife]

This reeks of someone who hasn't seen the country outside of LA or the I-95 corridor.

 

[managedcarefin]

Who has a very long wait time?

This troll is too obvious. In middle America would like to have a word with you.

 

[NecFasc92]

Can you show us where the midlevel hurt you?

I mean while over the top he does present solid points at times.

Midlevles hurt resident education, medical student education, and they provide literally nothing to the medical team. They are a power play by the suites which allow them to rack up more money while allowing attendings to maintain their laziness. It’s honestly one of the best/ saddest scams of the 21st century

 

[electropartyogram]

I mean while over the top he does present solid points at times.

Midlevles hurt resident education, medical student education, and they provide literally nothing to the medical team. They are a power play by the suites which allow them to rack up more money while allowing attendings to maintain their laziness. It’s honestly one of the best/ saddest scams of the 21st century

You seem to be very uninformed and misguided.

 

[NickNaylor]

I mean while over the top he does present solid points at times.

Midlevles hurt resident education, medical student education, and they provide literally nothing to the medical team. They are a power play by the suites which allow them to rack up more money while allowing attendings to maintain their laziness. It’s honestly one of the best/ saddest scams of the 21st century

That's certainly one way to look at it. Another way to look at it is that midlevels provide a useful service to generally overfilled and understaffed clinic systems (be they hospital or otherwise) and allow physicians to focus on care that actually requires physician-level skills rather low acuity situations that do not require physician input at all or indirect supervision.

I'm not a fan of the increasing role of midlevels in healthcare either, however to say that they offer "literally nothing to the medical team" is flat-out wrong. The service that I work on has a PA and she is incredible, does a lot of work that saves the physicians a TON of time, and is a good clinician. Our service is 100% better with her present.

 

[PieOHmy]

If anything we have too many residencies and far farrr too many midlevels (if you look job apps:jobs ratio).
We also have a lot of residencies providing subpar or bad training. This is due to: lack of patient volume and pathology, inadequate staff and lack of resources. There are only so many complex patients to go around and only so many physicians who are good educators (most are not).
In addition, we have an oversupply of doctors in desirable areas of the country.

Just putting this out there because a lot of people seem to be drinking the shortage kool aid. There is none. There is certainly a distribution issue when it comes to rural areas but even that is exaggerated in 2019. But "shortages" are fabricated in order to increase supply to drive down salaries.

I applaud you for NOT drinking the kool aid. Anytime one of these(think thanks, health care organizations etc etc) clowns tells you something as fact...... the opposite is usually true...

 

[PieOHmy]

I mean while over the top he does present solid points at times.

Midlevles hurt resident education, medical student education, and they provide literally nothing to the medical team. They are a power play by the suites which allow them to rack up more money while allowing attendings to maintain their laziness. It’s honestly one of the best/ saddest scams of the 21st century

I agree with you that they are a power play by the suits but they are not useless and they dont hurt medical education especially PAs. Nurse practitioners should not even be even part of the conversation because their education and preparation are woefully inadequate and dangerous.

 

[MedicineZ0Z]

I mean while over the top he does present solid points at times.

Midlevles hurt resident education, medical student education, and they provide literally nothing to the medical team. They are a power play by the suites which allow them to rack up more money while allowing attendings to maintain their laziness. It’s honestly one of the best/ saddest scams of the 21st century

I agree with you that they are a power play by the suits but they are not useless and they dont hurt medical education especially PAs. Nurse practitioners should not even be even part of the conversation because their education and preparation are woefully inadequate and dangerous.

That's certainly one way to look at it. Another way to look at it is that midlevels provide a useful service to generally overfilled and understaffed clinic systems (be they hospital or otherwise) and allow physicians to focus on care that actually requires physician-level skills rather low acuity situations that do not require physician input at all or indirect supervision.

I'm not a fan of the increasing role of midlevels in healthcare either, however to say that they offer "literally nothing to the medical team" is flat-out wrong. The service that I work on has a PA and she is incredible, does a lot of work that saves the physicians a TON of time, and is a good clinician. Our service is 100% better with her present.

You seem to be very uninformed and misguided.

Should I begin copy pasting the daily threads on reddit about midlevels who take procedures away from residents!?

 

[NickNaylor]

Should I begin copy pasting the daily threads on reddit about midlevels who take procedures away from residents!?

Potentially negative impacts on medical student/resident education does not, in my view, mean that we should suddenly get rid of all midlevels.

 

[MedicineZ0Z]

Potentially negative impacts on medical student/resident education does not, in my view, mean that we should suddenly get rid of all midlevels.

It's not potential. It's obvious and severe. It also needs a solution.

 

[VA Hopeful Dr]

It's not potential. It's obvious and severe. It also needs a solution.

Depending on the circumstances, that could be true.

 

[electropartyogram]

That's why you can't have a blanket law that applies across the U.S. because there are different needs in different places. Middle America and at places without residencies and a limited number of physicians? Midlevels are absolutely needed. In larger cities with an abundance of physicians, residents, and midlevels? Yes, there is saturation but that does not mean they are not needed and certainly not to the severity you indicate.

Imagine passing a law that mandated a physician be involved with every case. There are some anesthesia groups that only employ CRNAs. These are practices that have been around a long time as well, they can't just be removed.

 

[ace_inhibitor111]

I agree with you. 25 years ago everyone was saying there would be too many doctors, now the AAMC is saying there’s a huge shortage. The US Bureau of Labor Statistics predicted a 15% increase in medical jobs back in 2015, now it’s down to 13%. No one really knows what is going to happen. One thing for sure though, if the AAMC’s predictions are wrong and we’re just pumping out a ton of new doctors, things could go way south in terms of the job market for certain specialties.

It’s the one thing holding me back from EM. The number of EM residences has been increasing by 10% yearly, but for the US population it’s more like 2%. If that trend continues I can’t imagine the reimbursement will be the same 10-15 years from now.

 

[PieOHmy]

It also needs a solution.

It does need a solution, but so do many things in this world. Dont hold your breath for anybody to create solutions that do not affect them (especially the worthless politicians in washington). Once it starts to affect them,(directly or indirectly) thats when perhaps you will see some action.
Thats why term limits are important and to vote all these worthless sacks of garbage out of office.

 

[BorderlineQueen]

Why don’t you send a letter containing your thoughts to the AMA or AGCME and let us know how it goes? Also I don’t know how anyone can support your position without facts and data. Anecdotes are not as strong as facts and data so if you have any data please post it.

 

[Goro]

I agree with you. 25 years ago everyone was saying there would be too many doctors, now the AAMC is saying there’s a huge shortage. The US Bureau of Labor Statistics predicted a 15% increase in medical jobs back in 2015, now it’s down to 13%. No one really knows what is going to happen. One thing for sure though, if the AAMC’s predictions are wrong and we’re just pumping out a ton of new doctors, things could go way south in terms of the job market for certain specialties.

It’s the one thing holding me back from EM. The number of EM residences has been increasing by 10% yearly, but for the US population it’s more like 2%. If that trend continues I can’t imagine the reimbursement will be the same 10-15 years from now.

As others have mentioned, there is not doctor shortage, but a maldistribution. And until doctors want to practice in rural West VA or Casper, WY, then midlevels will be filling that gap.

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

 

[DO2015CA]

As others have mentioned, there is not doctor shortage, but a maldistribution. And until doctors want to practice in rural West VA or Casper, WY, then midlevels will be filling that gap.

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

Last paragraph, do you mean doctor oversupply?

 

[Goro]

Last paragraph, do you mean doctor oversupply?

Nope

 

[VA Hopeful Dr]

As others have mentioned, there is not doctor shortage, but a maldistribution. And until doctors want to practice in rural West VA or Casper, WY, then midlevels will be filling that gap.

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

As a guy paid on production, I'm looking forward to that retirement rush

 

[PieOHmy]

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

Guess what?!!! If all of the docs are retiring at 50 -55 you will have massive problems with shortage in the future. Solve the problems of retiring docs,,,, and you are well on your way of solving the problems

 

[PieOHmy]

Guess what?!!! If all of the docs are retiring at 50 -55 you will have massive problems with shortage in the future. Solve the problems of retiring docs,,,, and you are well on your way of solving the problems. Plus make the reimbursement of rural areas 2x normal area. problem solved

 

[NecFasc92]

You seem to be very uninformed and misguided.

Not really, pre-med. I was a hosp admin before med school. Maybe know your audience before speaking, Ive been in the game since you were learning how to multiply

You remind me of the third years on rounds who try to argue with senior residents and attendings. Yikes. Good luck.

 

[Mass Effect]

Who has a very long wait time?

Psychiatry, for one. It takes 12 weeks for a new patient appointment in my metro East Coast clinic.

Also, aren't you the same poster who just questioned how documentation can help a physician in a lawsuit on the General Residency forum? That reinforces the belief that either you're trolling or you're extremely new to the field of medicine.

 

[managedcarefin]

Not really, pre-med. I was a hosp admin before med school. Maybe know your audience before speaking, Ive been in the game since you were learning how to multiply

You remind me of the third years on rounds who try to argue with senior residents and attendings. Yikes. Good luck.

What did you do as a hosp admin?

 

[BorderlineQueen]

Guess what?!!! If all of the docs are retiring at 50 -55 you will have massive problems with shortage in the future. Solve the problems of retiring docs,,,, and you are well on your way of solving the problems

Citation required please. For example 60% psychiatrists are over the age of 55. Addressing the escalating psychiatrist shortage A study found that most doctors work until the age of 68. https://www.physicianspractice.com/physicians-hesitant-retire-study-finds Only 12% of physicnas retire before the age of 60. Early retirement? 5 factors physicians should evaluate So your anecdote that most doctors retire between age 50-55 is wrong the data does not support your assumption .

 

[ace_inhibitor111]

We got doctors who are 70+ and still working so I wouldn’t hold your breath on there being a mass retirement. Of course, the AAMC did all the math accounting for retirement in the past, and on the graphs they created oversupply was still a distinct possibility.

Psychiatry, for one. It takes 12 weeks for a new patient appointment in my metro East Coast clinic.

Also, aren't you the same poster who just questioned how documentation can help a physician in a lawsuit on the General Residency forum? That reinforces the belief that either you're trolling or you're extremely new to the field of medicine.

That’s likely confounded by insurance coverage and distance. My main dermatologist can sometimes take over a month for appointments, but if I choose another dermatologist I can see them in a week. If I’m willing to drive anywhere within a 25 mile radius, I can get an appointment the next day.

 

[Goro]

Guess what?!!! If all of the docs are retiring at 50 -55 you will have massive problems with shortage in the future. Solve the problems of retiring docs,,,, and you are well on your way of solving the problems

The Baby Boom docs are at a minimum, 55 years old. The oldest are 73. Split the difference and you have tons of people, like me, who are in their mid 60s. These people aren't going to live forever, much less retire at age 80.

 

[Matthew9Thirtyfive]

As others have mentioned, there is not doctor shortage, but a maldistribution. And until doctors want to practice in rural West VA or Casper, WY, then midlevels will be filling that gap.

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

Not that I’m jumping on the bandwagon, but the midlevels don’t really practice in those areas either. Most of them go to urban areas.

 

[PieOHmy]

Citation required please. For example 60% psychiatrists are over the age of 55. Addressing the escalating psychiatrist shortage A study found that most doctors work until the age of 68. https://www.physicianspractice.com/physicians-hesitant-retire-study-finds Only 12% of physicnas retire before the age of 60. Early retirement? 5 factors physicians should evaluate So your anecdote that most doctors retire between age 50-55 is wrong the data does not support your assumption .

One of your sources says Doctors work til they're 68 because of the love of medicine.

Does that sound like a source you want to believe?

But point well taken.

Your other sources says part of the drain on psychiatry is the low reimbursement.

Sounds like that is easily fixed.

 

[ace_inhibitor111]

As others have mentioned, there is not doctor shortage, but a maldistribution. And until doctors want to practice in rural West VA or Casper, WY, then midlevels will be filling that gap.

A doctor shortage does seem to be looming with the eventual retirement/die-off of all the Baby Boom docs, who still make up a significant number of the current clinician population in the US.

Because of how sparse some areas of America are, simply shipping doctors to the countryside doesn't exactly solve the problem. You put a doctor in the middle of rural Wyoming, and the majority of their patients will still be 1.5-2 hours away, because of how far everyone lives from one another. Peppering the countryside with doctors doesn't really help either, only makes it so that each doctor manages the few patients closest to them.

 

[BorderlineQueen]

One of your sources says Doctors work til they're 68 because of the love of medicine.

Does that sound like a source you want to believe?

But point well taken.

Your other sources says part of the drain on psychiatry is the low reimbursement.

Sounds like that is easily fixed.

It was from a credible study where they assessed what age physicians retire at. But I don't think reimbursing psychiatrist more would cause people to retire any faster but who knows. Psych is also less physically demanding than most specialties since you sit in a chair.

 

[WedgeDawg]

After discussion, the moderator team has decided that this discussion is more appropriately placed in the Topics in Healthcare forum. A 3 day redirection link will be left in the MD forum.

 

[PikminOC]

One of your sources says Doctors work til they're 68 because of the love of medicine.

Does that sound like a source you want to believe?

But point well taken.

Your other sources says part of the drain on psychiatry is the low reimbursement.

Sounds like that is easily fixed.

Easily fixed how?

 

[PieOHmy]

Easily fixed how?

easily fixable i meant. Pay them more.

 

[PikminOC]

Who will pay? Where will the money come from?

easily fixable i meant. Pay them more.

 

[PieOHmy]

Who will pay? Where will the money come from?

You cannot be serious!!!

 

[PikminOC]

You cannot be serious!!!

Let me in on it