Physician Shortage Caused by War on Terror

The Associated Press has finally noticed one of the most significant and dangerous trends in health care: physician shortages in rural America. Unfortunately, the reporter assigned to the story is bent on finding an explanation for this phenomenon among the usual tendentious journalistic tropes:

A national shortage of doctors is hitting poor places the hardest, and efforts to bring in foreign physicians to fill the gap are running into a knot of restrictions from the war on terror ….

In other words, the rural physician shortage could be easily solved if our country weren’t run by oil-hungry war mongers. If only we would stop allowing our foreign policy to be controlled by Halliburton, there would be no problem getting doctors to go to rural Mississippi and work for nothing.

Here’s a clue for the geniuses at AP: The rural physician shortage is caused by government price controls. Virtually all of the patients in rural areas are on Medicare and Medicaid, and CMS has mandated absurdly low reimbursement rates for the physicians who treat these folks.

So, the solution to the physician shortage isn’t to scale back the war on terror and import more doctors from overseas. The way to solve the problem is to eliminate the hopelessly Byzantine and inefficient price control structure created by the apparatchiks at CMS.

If these meddling bureaucrats would allow reimbursement to be determined by the market, there would be no rural physician shortage. Doctors, home-grown and foreign-born alike, would then be able to make a living in places like the Mississippi delta, and many would voluntarily choose to practice medicine there.

Meanwhile, it would be helpful if the various “news” media would stop using political bias as a Procrustean bed into which all stories must be forced, regardless of how poor the fit.

Comments 16

  1. Edward Sodaro MD wrote:

    Bingo! You nailed the Associated Press distortion and journalistic malpractice perfectly. Don’t AP reporters do even the slightest investigation?

    I would also add that the two cited shortage regions, The Delta region of Mississippi and Appalachian West Virginia, are rated notorious “judicial hellholes” having nightmarish physcian liability. Combined with ever diminishing reimbursement, the practice prospects in these areas is non-existent.

    Posted 22 Jul 2007 at 12:47 am
  2. Catron wrote:

    I don’t think AP reporters, or journalists in general, have much interest in checking out the facts or learning the nuances of health care economics. Their approach is purely ideological, and this is a great disservice to the public.

    Posted 22 Jul 2007 at 10:58 am
  3. Matt wrote:

    Bureacrats aren’t what’s keeping you from testing the market. You are.

    Doctors made a living in Mississippi and other places long before Medicare, and they could again – if they chose to.

    Besides, I thought tort reform was supposed to solve the problem of few physicians in rural areas! Mississippi has had it for a couple of years now. You mean that physicians still don’t want to live in largely poor, largely rural areas? And that rural areas have the same problems they’ve had since time immemorial in getting professionals? How stunning! Who would have thought it? Did the insurance industry lobbyists lie to us? Perish the thought!

    Posted 22 Jul 2007 at 12:02 pm
  4. Catron wrote:

    Bureaucrats aren’t what’s keeping you from testing the market. You are.

    Ya lost me on that one, Matt. I would be delighted to hear how doctors could make a living in Mississippi “if they chose to.”

    Posted 22 Jul 2007 at 1:28 pm
  5. Matt wrote:

    They could simply stop accepting Medicare, and do like professionals of every other kind in Mississippi, from lawyers to architects. Tell the patient the charge for the services and have them pay out of their pocket.

    Nothing whatsoever is stopping them from doing that.

    Posted 22 Jul 2007 at 2:32 pm
  6. Catron wrote:

    In rural areas, if you eliminate the folks on Medicare, Medicaid, and SCHIP, there aren’t enough patients left to support a practice (not even close).

    If you’re suggesting that they treat Medicare patients on a non-par basis, it reveals a profound naivete about how CMS works. It would be like “not participating” with Tony Soprano.

    Posted 22 Jul 2007 at 10:03 pm
  7. Matt wrote:

    How do you know what it could support? When was the last time anyone tried? In fact, didn’t Ron Paul do that very thing?

    Right now, how long would it take you to extricate yourself from your current employment and enter into the free market?

    Posted 22 Jul 2007 at 10:10 pm
  8. Catron wrote:

    How do you know what it could support?

    The numbers just aren’t there.

    Didn’t Ron Paul do that very thing?

    I doubt it.

    Posted 22 Jul 2007 at 10:32 pm
  9. Matt wrote:

    What numbers? The numbers that support every other professional in the town?

    And actually, Paul did. Refused Medicare, at least according to his bio.

    So again, how long would it take you to enter into the free market? You keep advocating it – what’s stopping you?

    Posted 22 Jul 2007 at 11:19 pm
  10. Catron wrote:

    When Ron Paul boasts that he “did not accept Medicare,? it’s like saying “I refuse campaign contributions from Martians.? He was an obstetrician, which means that his patients were not eligible for Medicare. How many pregnant seniors do you know? He’s just exploiting your naiveté.

    As to participating in the free market, the issue doesn’t apply to me personally. I’m just a lowly finance guy. But it doesn’t make any more sense to address this question to a physician. There is no free market in health care in this country. CMS has made the non-par environment so toxic that non-participation isn’t really a viable alternative.

    Posted 23 Jul 2007 at 6:29 am
  11. Matt wrote:

    That’s simply wrong – there is a free market. There are physicians out there practicing right now who accept no insurance and no Medicare/Medicaid.

    Why more aren’t doing it is a perfectly legitimate question. In the answer I bet you’ll see why they have the reimbursement system they do.

    Sorry, I meant Medicaid.

    Posted 23 Jul 2007 at 12:33 pm
  12. Catron wrote:

    Nope. Sorry. A primary care doc accepts CMS red tape or he does without 50% to 75% of his potential patient base. A free market allows a service provider access to the entire universe of potential customers in his price range, not 25% to 50%. Until CMS is reigned in, the market is anything but free.

    Posted 23 Jul 2007 at 5:46 pm
  13. Matt wrote:

    Again, this is nonsense. Do you own a business?

    You say “reigned in”, but what you really mean is “pay more”. You don’t want the market, you want the govt. to simply pay more to physicians. Physicians have the absolute choice to sign up with CMS, and you can’t blame them for doing so – after all, they get paid by a solvent party every time and it creates a damn fine standard of living. Maybe not as high as they’d like, but that’s the trade.

    Here’s a blog of a doc doing exactly what you say can’t be done, with links to other:

    Posted 24 Jul 2007 at 9:47 am
  14. Catron wrote:

    Matt, you continue to confuse assertions with fact. If what I say is nonsense, why don’t you provide an alternate narrative and some documentation to back it up?

    Posted 24 Jul 2007 at 10:49 am
  15. Matt wrote:

    You’ve provided no proof of your claims. You keep saying it’s impossible, and I linked you to the people who are doing it.

    You have this odd belief that if physicians keep agreeing to accept the govt.’s money on the terms that it’s offered, then the govt. is going to make the terms better out of goodness of their heart. Even a basic understanding of negotiations would indicate this isn’t true. Who bids against themselves?

    As for facts regarding the standard of living that doctors currently enjoy, the DOL has all those stats. No profession is paid higher.

    Posted 24 Jul 2007 at 11:08 am
  16. Catron wrote:

    Matt, you need to read the site you referred me to. He has a March post that proves my point.

    His payor mix is PPO 79%, Cash 13%, Medicare 4%, HMO 0%. Despite this highly favorable payor mix (high PPO %), he’s still struggling financially.

    The rural areas I’m talking about have a typical payor mix of PPO 10%, Cash 5%, Medicare 40%, Medicaid 35%, Indigent 10%. No micropractice could come close to surviving with that mix.

    Posted 24 Jul 2007 at 1:00 pm

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