The coming manpower shortage medicine is here

Here in South Florida it is more difficult to practice medicine than most places in the United States. The cost of living, the cost of hiring employees and the cost of insurance all runs up a cost which goes against the reduction in medical reimbursement which is by default, down 70% with Medicare. The insurance companies pay less than that; 10 or 20%. So, therefore, one has to go where the money is i.e., an employment situation which means you’re a donkey on a wheel or you go to personal injury and you take your chances with manufacturing a diagnosis for people allegedly injured in accidents.

So, what we have now is an economically unsustainable community of medical practice and to hone down on orthopedic surgeons is even more difficult. Orthopedic surgeons basically have an income stream based on their surgeries that they do. I practiced back in the mid 1980s and income is now 10 to 20% per case; total knees, total joints, etc.. and the insurance pays less. Obviously, the consumer price index has gone up tremendously, so therefore it’s unsustainable. So, you take a gentleman or a lady who’s trained for 12 to 14 years to be a medical doctor and what do they do? They’re $200,000.00 to $300,000.00 in debt and they have to at least pay that back, and they deserve to have a family, get married, have children and pay for it and have a reasonable lifestyle. That doesn’t happen.

Many people, and I have mentioned this 20 years ago, are advised not to go into medicine because this was foreseen. A very good friend of mine’s son went to MIT and decided to go into hedge funds, and he’s done very well. But the point is, is the manpower shortage in medicine has come to a head slowly. The article I wrote predicted this 10 years ago and it’s happening, and what’s happening now is that ERs and other urgent care facilities are going to be staffed by ARNPs or nurse practitioners because there aren’t going to be a lot of doctors.

In a recent article I’ve read, almost 60% of orthopedic surgeons are 55 years of age or older, and with the point of diminishing returns, they’re going to quit and they’re not going to be participating.

We need to have better medical care, but without paying for it, doctors aren’t going to work for nothing. And, the bottom line is, is you’re going to substitute other people in the medical mix to allegedly diagnose things, and diagnosis is something that’s sacrosanct with a physician’s training. Cognitive aspect of that thinking has been destroyed with electronic medical records; anyone that has filled out a form for anything on a computer. It’s a yes, no, yes, no, yes, no, and that does not clarify a diagnosis.

So, the dissatisfaction of record keeping, the push of electronic medical records, the highly needed training that doesn’t happen anymore, the lack of economic sustainability has reduced the number of doctors and orthopedists that really want to practice medicine, and since you can’t do it, the smart, bright people are going to go somewhere else. I would challenge to say that maybe the qualifications of new medical school graduates will be diminished. I’m not saying they’re not smart, but the bright, intelligent people that went into medicine years ago may not be there anymore. So, we have a multiplicity of factors that are going into the fact that we are going to face a manpower shortage in orthopedics and medicine in the near future specifically the next 10 years.

But, what’s the answer? The answer, basically is one of reimbursement adequately, and what is adequate reimbursement? I’ve been in Washington, D.C., and a doctor can’t see a Congressman about not making enough money, because everybody thinks you make a half a million dollars a year and that’s just not the case, unless you do unscrupulous surgeries or fit into one of the other issues that I just mentioned: employment, etc. The change should be championing the doctors in the trenches; the ones that are working. There has to be a pushback to the insurance companies, and a perfect example is a website called www.fairhealthconsumer.org.

Fairhealthconsumer.org was put together by Governor Cuomo of New York who’s now since passed away, when he found out United Healthcare was using another company to down code their own codes, so they paid out less. That company was called Ingenix, I-N-G-E N I X, and when Cuomo found out that United Healthcare owned Ingenix, it was basically down coding itself. Then he filed a lawsuit, got a settlement of $20 million plus, and he created fairhealthconsumer.org which gives a proper indemnity coverage reimbursement 75, 85, and 95th Percentile, and when one compares that to Medicare percentiles, one will realize the discrepancy and the lack of economic sustainability.

I believe if we really want good medical care in the United States, we need to start with some kind of dictum to increase the reimbursement on a fee for service basis not a salary for physicians, and that’s pushing uphill tremendously between the politics of insurance, the politics of hospitals, which have now gained control of medical care and employing doctors. It’s going to be a hard-fought battle, but the solution is to raise the salary and raise the income for doctors so it’s sustainable. And, I think how that is going to be done is going to be a business and a governmental regulation problem which may or may not happen in the future.