Is there a doctor in the house?

Post lifted from Democracy Project. See the original for links

What happens if "universal healthcare" is decreed, and there's no doctor in the house? What happens when the proponents of "universal healthcare" also castigate the best and brightest who choose to endure the rigors of medical training by reducing their financial incentive? A report in the Wall Street Journal says that the Massachusetts experiment in "universal healthcare" may founder on the lack of enough primary care physicians:

State officials have acknowledged the problem. "Health-care coverage without access is meaningless," Gov. Deval Patrick said in March.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

A principal reason: too little money for too much work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colo. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.

At the same time, the workweek for primary-care doctors has lengthened, and they are seeing more patients. The advent of managed care in the mid-1990s added to the burden as insurance companies called on primary-care doctors to serve as gatekeepers for their patients' referrals to specialty medicine.

An op-ed in USA Today, by an immigration lawyer, delves further, with attention to the British experience with terrorist doctors. Strict screening is the key.

Why haven't we heard any links of these foreign physicians to terrorism in the USA? Most likely because of the extensive background checks that all skilled workers, including doctors, undergo before being admitted. British security clearances for skilled workers are not as extensive, and the process is under review. It might help to know some basic data:

* Physicians in the USA: 794,893.

* Foreign graduate doctors in the USA: 185,234 (from 127 countries).

* Percentage of doctors in U.S. training programs who are foreigners: 24%.

This is not a new phenomenon. Foreign physicians have made up about this percentage of our doctor population for years. A sizable portion work in medically underserved communities and small towns. This at a time when a shortage of doctors in the USA is expected to grow to as much as 200,000 by 2020. Why is this shortage happening?

First, the USA has opened almost no new medical schools in the past 25 years. So you have a physician population that has remained flat serving a U.S. population that is expected to grow by 25% between 2000 and 2025.

Major demographic changes in the physician population also must be considered. Nearly one-third of doctors are older than 55, with more choosing early retirement. Fifty percent of all medical school graduates are now women. That is affecting both the total hours worked each year as well as the number of specialists. Family demands are causing many women to reduce their hours or to leave the profession when they have children. Some women doctors avoid fields with difficult call hours, such as anesthesiology and radiology.

Then there are our own demographic changes. The number of Americans older than 65 will increase to 54 million by 2020. As we age, our need for medical care increases.

Finally, as more treatment options are available and new technology is developed, Americans are more likely to seek out the services of a physician or specialist.

NHS neglects kids

Children with cancer are less likely to survive in Britain than in other European countries, two specialists have claimed. The reason could be slower detection of the cancers or less aggressive treatment once they are diagnosed, according to Alan Craft, of the Institute of Child Health at Newcastle University, and Kathy Pritchard-Jones, of the Institute of Cancer Research in Sutton, southwest London.

Writing in The Lancet Oncology, Professor Craft and Professor Pritchard-Jones say that, despite a National Service Framework for Children that sets standards for care, there are no targets and children "continue to be a low priority for the NHS".

They highlight trials carried out on Wilms's tumour - a childhood condition - in Germany, which showed that, between 1994 and 2001, 27.4 per cent of patients had a cancer that was first identified during a visit to a health professional for an unrelated problem, or by routine surveillance.

By comparison, in Britain, only 11 per cent of patients treated at the Royal Marsden Hospital, London, and 4 per cent of those referred to Newcastle General Hospital or the Royal Victoria Infirmary, Newcastle upon Tyne, were identified in this way. This suggests that GPs, and possibly some specialists, are slow to detect the cancers, thereby delaying treatment. In Germany, early diagnosis by routine or incidental examination is linked to increased survival, they say.

Routine health surveillance systems and opportunities for diagnosis for children may also be worse in Britain. In Germany most children have a primary-care paediatrician who provides regular check-ups, whereas in Britain the guidelines are not as thorough, the authors say. They conclude: "Sub-optimum survival for childhood cancer is just one example of the worse state of children's healthcare in the UK compared with many other countries. "The perinatal mortality rate puts the UK in fifteenth position in Europe and there is clear evidence that children with diabetes are [also] not receiving optimum care."

However, Professor Alex Markham, a former chief executive of Cancer Research UK and now its senior medical adviser, said that overall survival rates from childhood cancer in Britain had reached 77 per cent, and for some types of the disease survival was more than 90 per cent. "The data discussed in this comment in Lancet Oncology were collected between 1977 and 1997. Some of these apparent survival differences might be down to variations in the way data are collected in different countries," he said.

Roisin Trehy, senior nurse with Cancerbackup, said: "Any evidence to suggest that children are not a health priority is hugely concerning. However, this research does not seem to take account of the fact that, until the end of the trial period in 1997, the UK did not have a multidisciplinary team approach to cancer care."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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