Doctor Shortage-Who Should Fill the Gap?

I dont think medicine has made it difficult for foreing docs to come to the USA. For the last 5 years (at least) Internal medicine programs fill 50% of their spots with IMG's and Family Medicine almost over 60% and every year there are less spaces unfilled for this two specialties after the match. If it was difficult for IMG's to come over here I would expect the unfilled spaces to go up instead of down.

If looking for stats go to the NRMP webpage.

"In the defense of MD's, they have massive amounts in loans and need to make a high salary to pay them back any time before they are fifty. I am sure it is not fun to be walking around at 35 with $200,000 in loans hangin over your head. On the other hand at the salary most specialists make they can no doubt pay this off in short order. NPs and PAs on the other hand are not in this level of debt" quote from Misplaced1's post#1
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.

When I looked at the quote above, I had the same knee-jerk reaction to it, that others have expressed about those who can't afford health insurance.
It seems to me that no one but doctors have to pay their debts. It would be good if a government program similar to the bill for modification of loans for mortgages might take place, to lower the interest rate for the loans incurred earlier, so that our communities could have medical practitioners. Also, a cap on the price of education needs to be in place, as the costs of text books, labs, etc. is prohibitive. Many academic credits could be obtained on the internet (as continuing education is now), without the need for expensive housing in college towns and big cities, transportation costs, and additional cool clothing, etc. to lower the price of the road to getting degrees.

While my educational costs for becoming a R.N. at a hospital program were negligable, back in the "dark ages", I knew that university was an impossibility, until a "bursary" fell into my lap for my Public Health Nursing degree (which isn't even a route to a BScN now. I did have to promise to work at least a year in a rural area in the province which gave me the money (that was a need seen in 1961 in Canada).

Equipment needs costs in private doctors' offices could be mitigated by central, convenient centers in regional hospitals, where studies on line would be done and provided physicians immediately, and lowering the price of having their own office. I almost fell over while watching "the Doctors"last week, when one of them stated that a small new piece of equipment he was using to treat some problems cost $100,000. There was also a new ultrasound demonstrated that would provide early diagnosis of ovarian cancer and obviate "archaic" pelvic exams as often as they're done now. Just as women go for mammograms now, they can get less painful trans vaginal ultrasounds as regularly as needed, without the hesitation many women display by missing annual pap smears.

Also billing costs done for the public health care program would be included in the processing of health care costs, at a central location.

When loans became available for medical students, the banks rushed to the rescue for them, envisioning lucrative medical practises, further loans for newer equipment throughtout that individual's career, their homes, etc. Doctors have become the lending industry's "cash cow". Therefore large American cities have plenty of doctors, so many that the rite of seeing "Primary Care Providers" as a revolving door to get specialists' care, began and insurers required that route.

However in the rural areas, going to a specialist is next to impossible, and that's where the "shortage" has always been a fact of life. President Obama saw that, which is why our new Surgeon General is a country physician who makes house calls, she paid for her own clinic using her own credit cards, and will be able to forage health care for those living far from cities. The need for that has been exemplified by the deaths of pregnant women and their neonates, who contract swine/A/H1N1 flu, far from practitioners/pharmacies with Tamiflu. It could be a condition of funding medical education, that new doctors work in country locations as primary care providers there. Their recent knowledge of where there are medical centers with good specialized care, with appropriate referrals of those requiring that.

That means that funding for the transportation, food and lodging of patients and their support persons going to bigger cities for care, would need to be organized effectively.

I would imagine that supplies of the vaccine being manufactured now, to prevent more carnage from the H1N1 pandemic, will be made available as a priority in the rural areas, as well as cities, for pregnant women, then health care workers, and the rest of the population.

For the next 5 years at least, while waves of that flu continue, the need for medical practitioners (MDs, NPs, PAs; and R.N.s and LPNs) will be greater than it has ever been. Therefore it would be prudent for our government's health care plan to implement funding (as it is doing) for the educational programs leading to more people in those professions.

The future holds much promise of quality living, with affordable health care for all, with the option of a public program and relief of high cost private insurance.

Amen to that. My poor med. student neighbor has a close to 300,000 student loan. She's losing her hair and has only one friend.

The point that MedSurg32RN was making, which is correct, is that it is impossible for foreign MDs to come to the US and simply get a license to practice as an MD, based on their foreign license and experience, and start practicing independently. The US medical community requires that, if they want to practice in the US, they must get accepted into a US residency program and complete a full residency -- regardless of how many years or decades of experience they have. Foreign RNs can just get a US state license and start working, in many (most) cases (if they have a visa/GC that permits them to work here legally).

I wish that the US nursing community would do as good a job of protecting the interests of US nurses as the US medical community has done protecting the interests of US physicians!

http://www.managedcaremag.com/archiv....shortage.html

Doctor shortage

A 2005 study by the Council on Graduate Medical Education (COGME) estimated there will be a shortage of at least 85,000 physicians in 2020. A 2006 study by the Health Resources and Services Administration predicted a shortage of at least 55,000 doctors.

The HRSA predicts that the demand for practicing doctors will increase from 713,800 in 2000 to 921,500 in 2020 — 22 percent. The demand for primary care doctors will increase 20 percent to 337,400, while specialist demand will increase 23 percent to 584,100

Seems to me, an Advance practice RN, that although I believe that most patients coming in to see their provider do just fine with a NP or PA. These practicioners have the ability and responsibility to refer the patient to the MD when necessary. This keeps the cost down, pt access much faster and uses the MD for the necessary xtra knowledge that they have.
There is room for everyone if everyone works within their scope.
CRNAs are the only APN that does the exact same job as the MD only because we came before they did. That being said, there are docs out there that are more experienced in certain types of cases and techniques than I am for example and the patient would be better served if they were to be referred in those cases to a MDA.
There is room for all; the babyboomers are coming on fast, we'd best get this figured out!

NPs are the salvation of the medical profession.

I don't care about the "debt that MDs' have". I for one have been attended two of the most expensive private and exclusive liberal arts instituions of higher learning WITH scholoarships and still managed to wrangle up close to 200K in student loans( ten years of higher ed will do that) . I'm an RN with a masters degree in an outside field. Do I deserve rescue? No, because I am training to be an NP. NOT to fill in the gaps for MD's (it's easier to get into med school than nursing school these days with the shortage of nursing school teachers). I want to be an NP because I believe in using my prescriptive and diagnostic authoritto care for the patient, his/her socio/economic situation, his or her RESPONSE to the DI eaese process. I could care less about histology and the disease process. I'm more concerned about " how does the disease process affect you". That is what separates nursing from medicine. And I think that you will find that consumers will begin to migrate to people who are more concerned about the "how does this DIS ease affect you? than the histology and eradication of illness."

Already there is a trend at my hospital where the RN's are the ones responsible for obtaining consent. My patients are clueless about their procedure and what it involves and no MD has spoken to them about it. So I have to use my nursing knowlegde to explain the procedure, expected outcomes, unexpected oucomes, etc. It is totally illegal, yes I know, but I know that my hospital is not the only one that does this

MD's are amazing resources, but I find myself spending more time protecting my patients from bad MD decisions than not. The Format/template of the NP is the wave of the future and MD's will simply be consultants. Heavens know I have a better chance at getting an appointment with god than my own MD. Time for an NP to take over my primary care, don't you think?

My mother in law went to see her doctor a week or so ago and was seen by an NP. Then she was charged the same amount as if she had seen the MD (who never came in the room).

Mundinger is fighting for the same amount of Medicare reimbursements for DNPs as MDs. How does all this keep costs down if the charges are the same?

(Keep in mind that Mundinger is an "outlier" in the NP world -- she is largely on her own personal crusade, and definitely does not speak for the larger NP community.)