No primary care in Massachusetts

There is a coming shortage of doctors, but only partially–the real shortage will be with primary care physicians and other general practitioners. This article explains:

Typically, teaching hospitals and other sponsors of residency programs receive subsidies amounting to about $100,000 per year for every resident they enroll, with about half of that going to the residents themselves in the form of stipends. Add in the additional money flowing from state Medicaid programs, and the public cost of residency programs comes to about $500,000 for every physician the hospitals produce.

The AAMC and its allies are very intent that Congress not cut these subsidies, and, indeed, want them raised. Without greater subsidies, the AAMC argues, America will face a shortage of 91,500 doctors by 2020. Just in case you don’t get the intended message, a video produced by the AAMC explains that unless the feds put more money into residency programs, Obamacare will bring “insurance in name only.”

But there is a big problem with this argument. America does indeed face a looming shortage of medical professionals, but because of the way it’s spent, that $13 billion subsidy isn’t helping us fill the gap. The nation’s residency programs are producing too many of the wrong kinds of doctors in the wrong places, while not producing enough of the kinds of doctors we most need to sustain the U.S. health care system.

Specifically, the programs turn out too many specialists who go on to practice in places where such doctors are already in oversupply, and where, according to numerous studies, they often inflate health care spending by engaging in massive amounts of unnecessary surgery and other forms of over-treatment. Meanwhile, residency programs are producing a dwindling number of primary care physicians and other generalists, who are already in chronically short supply in most parts of the country and are desperately needed to implement the kind of reforms to the health care delivery system necessary to improve its quality and efficiency.

The article notes that one of the reasons for this is that specialists control the Medicare board that assigns prices which means that specialists make more money and so more students towards a specialty field. Another piece becomes obvious in the hospitals that have the fewest residents going into general practice–hospitals like Children’s, Beth Israel, Brigham and Women’s, and Mass. General in Boston are all in the bottom 20. These are elite institutions associated with Harvard and thus they want to turn out doctors who are high-profile because it helps keep Harvard’s reputation high. General practice doctors don’t tend to get the attention that cutting edge specialists do and so Harvard doesn’t graduate general practice doctors very often. Which is bad for the country.

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