The War On Doctors Must Stop
They can no longer prescribe pain medication for those who really need it.
Many doctors these days have felt the heavy lash of the DEA. For those of you who are not drug traffickers, that is the Drug Enforcement Agency. This is supposed to protect patients who are on opiate-based medications from becoming heroin addicts.
Here is the problem: Hate to inform you dear government bureaucracy, but not all of us are in danger of being addicted to hard drugs. In fact, most of us are not addicted to any drugs. If someone gets addicted to opiates why does that become my problem?
Meanwhile, as a plastic surgery enthusiast, and I as an older woman who has had many medical surgeries, I say, “Keep your mitts off my doctor (s.)” They are trying to do the very best job for me, the Patient. Note that I use a capital letter.
I am a registered nurse, now retired, and I am so very sick of this war on doctors. I hate to inform you of this dear public—we are experiencing a shortage of doctors and that shortage will affect every man, woman and child in the USA, regardless of race, religion or economic status.
It used to be that 50-years-ago, many a Jewish mother would proudly talk about “…my son, the doctor.” Those days are over. Although we all need medical attention, the smart money does not go towards a medical degree anymore.
There are just too many other options. I visited an exceptional urologist here in Puerto Rico once, and he confessed that he was still paying off his undergraduate loans from MIT.
I judged his age at the time his age to be hovering around 50. I blame the University/Industrial Complex. American universities and colleges are vastly overpriced. We do have a wonderful medical school on the island, The University of Puerto Rico. Instead of charging an arm, a leg, a heart, a liver, and a brain for tuition, UPR is an affordable $10,000 a year.
As one can imagine, this is such a bargain that only the cream of the crop gets in. If I happen to see UPR on a doctor’s resume, I know that I have struck pure gold.
Even as the nation’s health care workforce combats the spread and lethality of COVID-19, a report from the Association of American Medical Colleges (AAMC) projects that the United States will face a shortage of between 54,100 and 139,000 physicians by 2033.
That survey was done before Covid, so perhaps the problem has deteriorated further. One can hardly expect that it has improved. A website, Nomad Health concurs. According to that site, these are states with the highest shortages of PCP’s, (primary care physicians.)
States With The Worst Physician To Population Ratio
The average number of physicians per population of 100,000 people in the US is 271.6. The ratio for each of these 10 states falls well below that average.
Rank/State
Mississippi
2. Idaho
Wyoming
Nevada
5. Arkansas
6. Oklahoma
7. Utah
Iowa
9. Alabama
10. Texas
A continuing trend is that rural areas are the ground zero for all physicians, both primary and specialists. Other factors are a lack of resident doctor programs.
For those of you who are not in the medical field, a resident is an individual who has passed their medical boards. So, they are doctors, but a residency allows them to apply their education to real-life scenarios. A good residency provides a scope of patients with complicated medical histories. Note: No doctor can practice medicine without a resideny. Ever. That is why the government is attempting to increase the pool of residencies. This may be one of the few taxpayer funded programs I am personally in favor of.
Some residents go on to be Fellows. Think of a Fellow as a doctor who gets precise, extended training in a narrow specialty. Last night, my husband and I watched a 2007 rerun of the TV series House. As a worldwide respected diagnostician, that episode focused on the cut throat competition to snare a Fellowship with House.
I confess that I wish there really was a Dr. House, but that show both amuses and educates the public. A fellow has much more autonomy than a resident, but not as much as an experienced Attending physician. The competition for both residencies and fellowships are as sharp as your average shark’s teeth—great job that I chose nursing instead! Although my job was intensely taxing, it was also extremely informative about both medicine and all its
One patient may be a pregnant schizophrenic with a genetic bone disease like Paget’s. This patient may arrive on a psychiatric unit in great pain as their leg or shoulder may be broken; the psychiatric resident must treat both the mental emergency and the broken bone. This patient may be totally oblivious and uncooperative.
I am using this example because I was an RN in a medical/psychiatric unit so I did see a jigsaw puzzle of mental and physical problems. In fact, psychiatry runs on the Axis system, which attempts to categorize all aspects of a patient’s life, including socio-economic.
We humans love to categorize people, places and events into nice neat boxes. This is all fine and well, except when this patient with a broken bone shows up and is combative; that is where an excellent psychiatric nurse comes in handy. She or he can gain the patient’s trust, get her x-rayed, and if she is me—medicate with both pain and tranquilizers and send the very best mental health tech with her to x-ray.
There were times when I went along for the ride, my hands patting the patient’s shoulder now and then while my facial expression telegraphed a mixture of confidence and caring.
Meanwhile, according to the magazine Health Finance, we will face a shortage of 90,000 by 2025. Oy Veh! Yours truly may even be alive then. So will the majority of my readers.
According to a Harvard Business Review article published in 2020, the real problem is not a shortage, but how we utilize the doctors we have. For example, by 2025, there should be an additional 190,000 primary care doctors who are not pediatricians. Also, there still exists the uninsured, (14%,) who cannot afford the services of any doctor.
This article goes on to explain that many practices do not want additional Medicaid or Medicare patients. These programs are known to be “slow and low,” payers. Electric companies, landlords and staff demand the opposite of low and slow; they demand fast and timely.
Other reasons for the coming calamity are inconvenient office hours and the amount of time it takes to file claims for Medicare and an avalanche of insurance paperwork. One Philadelphia surgeon, who I have used for various cosmetic work, hired someone to deal with all insurance paperwork. Dr. Mary Stefanyszyn told me that her hire was to administer all Obamacare claims.
Considering the reams of paperwork that nefararious deed gave birth to, the doctor’s new clerk had a job that was better suited for two people.
Clarity is better, in my opinion, than agreement, so I am revealing that there was not one element about former President Obama that did not produce revulsion and loathing on my part.
So, as my duty to disclose is satisfied, and we shall continue to report on the meat and potatoes of this issue.
According to the The Harvard Review, paperwork takes 20-30% of your doctor’s time.. However, one doubts if the physician personally has to file the barrage of insurance-related paperwork. Perhaps supervise, and address critical issues, but I have not gone to an office in many years where the doctor personally manages payment.
One bright spot that we may all count on is technology. Our doctors can replace some visits with a Zoom call or even Whatsapp. These modalities should only be used, in my opinion, when the office visit is merely a matter of refilling medications or even instituting a new drug regimen.
Also , exceptional medical toys are on the market now. I am referring to Cardio Mobil and others. Still, while using technology, someone else must monitor and read the results. An advanced practice nurse, in league with the specialist, can be trained to read results. In fact, many nurses, not with advanced degrees, have been trained to read EKG’s.
But it is the MD or DO that must sign off on her work.
Common sense dictates that if there is someone breaks a bone, or sprouts a rash, then either an ER or office visit is necessary. In the US, many tasks in a medical office may be handled by use of a Nurse Practioner or Physician’s assistant.
Artificial Intelligence, coupled with a better delegation of work may cushion the effect of the doctor shortage. Surgery cannot be done with AI. Yet.
One can only hope . More importantly, every one of us can increase our immune systems and eat healthily, exercise and in my opinion, make sure to get more sleep, instead of less sleep. Americans are very sleep deprived population.
The sacrifice of fresh food over packaged food is something that is key to our national explosion of obesity and illness. This scope of this article is not sufficient to cover that subject in debth, so I shall leave it to the army of nutrionists who are already neck deep in that arena.
Some of the messaging has filtered through the media, hence the explosion—and profits of many nutritional supplement companies.
If instead, we grew a few vegetables, either in a small patch of your backyard, or, on an apartment balcony, our wallets would be thicker and our waists would be thinner.
Think about it. Compared to endless supermarket trips; it may save the most precious comodity— time.