With all the discussions about how to bring down the cost of health care in the United States, there is one I’m surprised few are discussing. Physician density. Or the supply of health care.
Cracked.com actually addressed the issue in an article about American health care: “Enormous wait times are caused by a serious Doctor shortage”. The cost of health care is also exacerbated by this.
The laughably and ineptly named Affordable Care Act resulted in massive increases in the cost of health care for the simple reason it inflated demand for health care without doing anything to bump the supply of it. And anyone who’s studied basic market economics knows that when demand goes up without a corresponding increase in supply, prices go up as a result.
No matter how much a lot of people might scream otherwise, health care is not immune from the law of supply and demand. That is why it’s called a law of economics.
And one metric of health care supply is physician density. And in that metric, the United States needs to play catch-up. Out of 184 states tracked by the Central Intelligence Agency’s World Fact Book, the United States ranks 58, with 2.55 physicians per 1,000 people.
Canada is, interestingly, 61st with 2.48. The United Kingdom is 46th at 2.81. One of the reasons it’s not uncommon to hear of rationing and waiting periods in both countries. Like the United States, the UK and Canada don’t have the physician supply to keep up with demand.
Greece ranks 5th with 6.26 physicians. Monaco ranks 3rd with 6.65. Spain is 19th at 3.82. Sweden and Switzerland are tied at 12th with 4.11. Norway ranks 9th with 4.42. Austria ranks 6th at 5.15.
Again, health care is not immune from the law of supply and demand. Yet no one is talking about health care supply. No one is talking about what can be done to provide for more people practicing medicine in the United States.
Some States are attempting to address the problem, typically by allowing for more nurses to practice independent of physicians. But this is really a matter for Congress and the Trump administration to address. Part of the “2 for 1” effort should address the regulations that make it more difficult for physicians to enter medical practice.
At the same time, Congress needs to address the near-monopoly control the American Medical Association has over physician supply in the United States. Let me put it this way, when we have students graduating from medical school unable to continue on to become licensed physicians due entirely to bureaucracy, we have a major problem that needs to be addressed.
On Match Day 2017, nearly 36,000 graduate MDs applied for 31,757 residency spots. And there have virtually always been more MD graduates than residency spots. Those who don’t get accepted into residency can never move on to actually practice medicine. This is something public policies can and should address.
According to an article in StatNews written in 2016, Missouri, Kansas, and Arkansas have passed laws that allow medical students to practice in underserved areas without first going through a residency. In Missouri the law was crafted by plastic surgeon Edmond Cabbabe, MD, who said that, without the law, “a lot end up wasting all of their education, because there is no place for them in the health care delivery system without having a residency”.
Kansas’s law targets graduates of the University of Kansas School of Medicine (“KU Med”) who aren’t able to move on to residency. A new type of license allows them to practice for two years under the supervision of fully-licensed physician, after which they are expected to obtain a residency.
And while the American Medical Association has called for more funding to open up more residency spots in the United States, without more supervising physicians, which requires more physicians period, we can’t have more residency spots.
So the United States really needs to enact policies that address the physician shortage, as if we don’t do that, we can’t really lower the cost of health care delivery in the United States.