August 25, 2012

things I've learned

     Most anybody will admit our healthcare system has some severe flaws.  Very few, though, will see through the political posturing to the inherent and deeper flaws.  So far, I've yet to see one meaningful policy idea put forth seriously.  Take for example the now Supreme Court validated Affordable Care Act.  It has both its defenders and detractors.  I've yet to hear anyone, though, address and propose a solution to one of its fatal flaws.  There are simply not enough doctors to address the increase in the number of patients that will have insurance.  Period.  Math is not on this law's side.  And it's going to get worse because it takes a good decade to train new doctors.  It's not like they can be cranked out in respone to an increased need in short order.
     There is a rule of thumb that for each decade of life, that represents one chronic or serious health problem.  So a 44 year old will typically have 4 problems and a 72 will probably have 7.  There is also a rule of thumb that an office visit should take between 15 and 20 minutes.  So when a 60 year old patient comes into the office with 6 problems, which problem am I supposed to ignore?  Their prior cancer history?  Their osteoarthritis?  Their hypertension?  Their diabetes?  Their high cholesterol?  Their bladder control problems?  I don't ignore any of them and end up spending a good 50 minutes with the patient.  That means the next 2.5 patient encounters are now backed up.  This happens daily.  How are physicians going to handle an increase in the number of patients?  That which cannot go on indefinitely, will not.


Steve Parker, M.D. said...

You remind me of my favorite quote from WhiteCoat's Call Room (a blog):

"Health care insurance doesn’t mean access to medical care any more than car insurance means you have access to a car."

Donut Army said...

Thanks for this insight. I'm not an MD, so this was a bit of an embarrassing insight for me - embarrassing, because, of course, it should be obvious that this will be an issue. We've been talking about the nursing shortage for so long, and colleges/universities have been ramping up their nursing programs to take advantage of all the new students ensured by the sweeping promises of endless jobs in nursing. But, we haven't really spoken about this.

Great blog. Stumbled on it this morning - good job!