It is a well-known fact that America suffers from nationwide shortages of primary care physicians.1 This shortage has caused headaches for both doctors and patients. However, I have an effective mid- to long-term solution to this problem.
My solution is to federally charter a dozen or so large medical schools that are geographically dispersed throughout the nation. This act of Congress is constitutionally permissible under the commerce clause because employee healthcare is a major concern and expense of businesses who engage in interstate commerce.
There will certainly be enough qualified med school applicants to fill these schools, which could enroll as many as 1000 students per class at each school. Right now, many of our qualified med school applicants are choosing Caribbean schools and osteopathic degrees because there are simply not enough positions for them in U.S. medical schools. Other would-be qualified applicants choose ancillary or altogether unrelated professions because medical school admission is too competitive.
You might think this ultra-competitiveness in U.S. MD schools (and even osteopathic colleges) results in more highly skilled doctors and superior care. If you think that, you would be mistaken. What we end up with is medical schools full of perfectionists – students with college GPAs that approach 4.0 and competitive type A personalities whose drive is fueled largely by fear of failure.
Perfectionists like that might be valuable in a profession such as astrophysics; but medicine is not only complex, it is dynamic and personal. We need doctors who can handle failure and know how to make tough decisions. After all, there is a saying that every doctor kills somebody. They must also communicate with patients and their families on an emotional level. And perhaps most importantly, doctors must admit when their philosophies, procedures, and quality of care are poor and ineffective. This frequently happens, but type A personalities are loathe to be honest and acknowledge their own incompetence, and then make changes and seek solutions.
Pouring thousands of new doctors a year into the marketplace will balance supply and demand. The profession will find relief quickly, like arteries relieved of high blood pressure. Now doctors will have more time to spend with patients and be less overworked and stressed, and their quality of care will improve. And doctors will have to compete for patients, another powerful motivation for them to improve care. Currently, “bad” doctors have as many patients as “good” doctors. Most patients are obliged to take whatever care they can get.
What about the cost? Granted, the venture is costly, but the return is likewise large, even in the short term. New medical residencies will provide inexpensive care for patients and increased revenues for hospitals. The price of office visits and medical procedures will drop as a result of the market economics discussed above. And the cost of insurance programs will subsequently decline, including government-sponsored insurance programs.
If we delay this relief, the situation will continue to deteriorate. Overworked and stressed out doctors tend to provide subpar healthcare. And patients who receive subpar healthcare tend to not recover from their illnesses, so they return to the doctor repeatedly. This exacerbates the problem by further straining schedules and thus leading to even worse care. Where will this downward spiral end? With the patient dying, the doctor quitting, Medicare and Medicaid going bankrupt? I do not want to find out.
Alexander Typaldos, JD
1Many Doctors Plan to Quit or Cut Back: Survey, November 18, 2008, http://news.yahoo.com/s/nm/20081118/us_nm/us_doctors_usa_survey;_ylt=AsuanTbXtgowlEJGt5xucHXLLJ94.