Thu, Mar

The Doctor Will See You Now...if "Now" Means 2-3 Months!


THE DOCTOR IS IN - It's no secret that trying to see a doctor in a timely manner is at best difficult, and at worst downright impossible.

Enter the COVID-19 pandemic, when too many patients avoided medical care altogether out of fear of contracting this uncertain and unpredictable virus, and now the issues of access can be downright dangerous to your health. 

Fortunately, most medical issues can wait--the words "want" and "need" come to mind. Yet discerning between those two words, and ditto the need to distinguish between the terms "medically indicated" and "medically necessary" is very difficult... 

...and when it's YOUR health then the need for urgency goes way up (at least by YOUR way of thinking). 

But resources are too limited, and the number of patients (which, interestingly is UP because of state/national universal healthcare efforts) creates a supply/demand scenario that will cause too many patients to see the need of too few doctors.  

Or to run to Urgent Visit or Emergency Room facilities in an inefficient manner. 

Aggravating this situation (which I suspect is hardly a surprise to anyone reading this) are the following problematic turn in recent trends: 

1) The "Great Resignation", the "Great Retirement", and "Quiet Quitting" have hit the medical profession to a degree that is likely much higher than with other professions: 

Electronic medical records, bureaucratic requirements and measurements, and the stresses of COVID-19 have caused waves of physicians and nurses to bail from their professions. Many who can retire do just that, or reduce the numbers of days they work, and/or just don't stick their neck out to overbook and kill themselves for the corporate masters who too often run medical groups. 

2) Aggravating this trend is the surprising and unaddressed shortage of medical and nursing schools needed to allow medically-minded individuals to achieve education and enter the medical workforce. 

Are more medical and nursing schools being built and opened (as in repurposing law schools, junior college campuses, and other facilities capable of accommodating the thousands of necessary openings for doctors, physician assistants (PAs), and nurses) in a sufficient manner? 

Absolutely not. 

Is it too goddamned hard to get into nursing or medical school? 

Sure is--when qualified students need "gap years" just to prove yourself and get into medical school (or PA school, or Nurse Practitioner school, or nursing school), it just shows how nonsensical the wait is. 

I am NOT a fan of "gap years" in general--young people might want a year or two to enjoy their youth, but if they're focused on a given profession, they need to be unencumbered from their careers. 

Are PAs and Nurse Practioners who have practiced 5-10 years or more capable of taking qualifying examinations and--if passed--capable of attending medical school? 

Yes, they ARE.  

When one takes into consideration how many physicians are seeing fewer patients (or doing "concierge medicine" or cosmetic medicine to focus on getting more income), the need to find medical professionals who will focus on their patients--and not themselves--is that much more paramount.  

3) The costs of medical training can be up to hundreds of thousands of dollars for a given student, making it a daunting challenge at best to achieve a degree, and will force too many graduates to enter fields or practices that don't serve the majority of our nation's medical needs. 

If President Biden, Governor Newsom, or the L.A. County Board of Supervisors want to "fix" medicine in the United States, the need to subsidize this amount and open more spaces will probably be more cost-effective than throwing money away on initiatives that don't always make financial sense. 

What would be an action plan for addressing the aforementioned crisis? This plan would include: 

1) Subsidizing more schools with private/public partnerships that include health plans and pharmaceutical manufacturers, as well as taxpayer-funded initiatives. Yes, they can avoid conflicts of interest if so mandated and monitored. 

2) Stop requiring more "patient satisfaction" requirements and start requiring more "patient access" and "medical outcomes" requirements for medical practitioners and medical groups to achieve higher reimbursement for their services.  

Too many "patient satisfaction" requirements reward physicians to see fewer patients at the expense of the many who want ANY treatment at all. Patient Satisfaction is important, but Patient Access and Medical Outcomes are MORE important. 

3) Flexibility with respect to overly-rigid and ergonomically-undoable oversight of faculty  preventing independence and education of students to become independent and strong purveyors of medical care. Oversight is critical...but not to the extent that residents graduate as immature and inexperienced quasi-professionals. 

Residency is not supposed to be easy, but chief residents need to be effectively faculty members (although they, too, need oversight). 

4) Require graduating students and residents to work in underserved medical centers and facilities in urban, rural, and overpopulated regions in the U.S. Giving up 2-4 years of one's life for more training and more paid-back debt is hardly too much to ask for taxpayers and physicians to achieve more health care. 

More to come on this challenging crisis. But it's one we must all confront and fix in our lifetimes...and for us to live LONGER lifetimes.



(Kenneth S. Alpern, M.D, is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud husband and father to a wonderful wife and two cherished children. He was termed out of the Mar Vista Community Council (MVCC) twice after two 9-year- stints as a Board member and is also a Board member of the Westside Village Homeowners Association. He previously co-chaired the MVCC Outreach, Planning, and Transportation/Infrastructure Committees for 10 years. He was previously co-chair of the CD11 Transportation Advisory Committee, the grassroots Friends of the Green Line (which focused on a Green Line/LAX connection), and the nonprofit Transit Coalition His latest project is his fictional online book entitled The Unforgotten Tales of Middle-Earth and can be reached at [email protected]. The views expressed in this article are solely those of Dr. Alpern.)