Friday, August 07, 2015

A free trade agreement prescription for doctors and their crocodile tears

Everyone sees the doctor once in awhile. They wear nice white smocks with suits and ties. They work in clean offices with secretaries, nurses and expensive equipment. They enjoy their work with patients, watching them improve or maintain their health over time. At least that was what they signed up for. Not so much anymore.

In March, Geneia released a career satisfaction survey with the following results:
Today, Geneia released the results of our nationwide career satisfaction survey of practicing physicians. The findings are alarming. For starters: 84% of physicians believe quality patient time may be a thing of the past, and 67% of those surveyed know a physician who is likely to stop practicing medicine in the next five years as the result of burnout.
Uh-oh. These findings are indeed alarming. They're getting burned out. They're working too hard. They're not having very much fun. How did this happen? From the same report:
In our survey, we asked physicians to describe in their own words the obstacles that detract from their “joy” in practicing medicine. We received comments from 416 physicians, and while 14 of them told us that they’re still experiencing joy in medicine, the rest—402 physicians—told us, in very clear terms, that they are not. Most often cited as the top complaint? The corporatization of medicine, and the resulting recordkeeping and patient quotas demanded.
That is not a pretty picture. Only 3% report joy in their jobs? This is what we're walking into when we see a primary care physician? Can physicians give us the best possible care when they're not happy with their jobs?

Geneia is asking one of the right questions: how did we get here? They point to a long term trend of doctors selling their practice to get out of the business side so that they could enjoy the patient side. Seems like a reasonable thing to do. They've outsourced much of the administration of their work so that they could focus on the patient. They've stopped minding their own business and now the corporations that run their business are seeking to externalize their costs onto those same doctors.

This is reflected in the complaints of some doctors as seeing more paperwork and fewer patients. Doctors are doing more menial tasks rather than seeing more patients. They are also seeing a reduction in compensation. Well, that might be expected when they stop minding their own business.

This is yet another example of public policy written by the 1%. A report released in 2014 by the American Association of Medical Colleges lays the blame squarely on Congress. Their report debunks some of the myths surrounding the doctor shortage we're seeing in America. It's not exactly a scathing indictment, but it does point out that Congress needs to increase the number of people that can get residency positions so that they can graduate and practice medicine, to wit:
MYTH: Simply increasing the number of medical school graduates will fix the physician shortage.
FACT: Increasing the number of medical students is a necessary first step to addressing the doctor shortage, but a doctor cannot practice independently without residency training (GME). Unless Congress increases Medicare support for GME, the number of physicians per capita will actually decrease.
On a national level, it's really up to Congress to increase the number of practicing physicians by increasing Medicare support. Unfortunately, we have a Congress with a majority of men and women dead set on reducing or eliminating the Medicare program. They sincerely believe that the free market can prevail once it is freed form the burdens of the government.

Who has been setting public policy for at least the last 20 years? The 1%. Who makes up a significant fraction of the 1%? Medical specialists earning at least $323,000 a year (that's where the 1% start).

Crocodile tears I say. The doctors made their own bed, let them sleep in it.

There is an interesting solution beyond just increasing Medicare residency. We have a shortage of doctors worldwide, especially in developing countries. Why not globalize health care? If Obama wants a trade deal to sign before he leaves office, I found a great idea that could do the trick.

The idea comes from economist Dean Baker director of the Center for Economic Policy Research. Here's the idea: create a worldwide standard for the practice of medicine. Then we bring medical students from abroad to train and study here. Then when they are licensed, they work here as doctors for a much smaller fraction of what domestic doctors earn, thereby driving down prices and meeting the demands for service.

Foreign residents would then pay a tax on their earnings which would be sent back home to finance the training of more doctors so that there is not a complete brain drain from the originating country. Foreign doctors living here and practicing medicine would be happy to work for say, $80,000 a year since their education is financed by the government anyway.

The last leg of this proposal would be to let the government finance medical tourism:
For example, heart surgery in a US hospital can easily cost more than $200,000. Hospitals in India and Thailand can offer comparable quality care for $25,000. This cost difference can easily cover the travel expenses of the patient and immediate family and still allow for enormous savings. 
That would be a trade deal worth working for, Mr. Obama. Forget TPP and TTIP. Let's globalize health care so that doctors can get back to the joys of practicing medicine again.
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