ALPERN AT LARGE - Wanna see a doctor on short notice, or even her/his PA or NP? Yeah, right…we all know how doggone hard that can be!
So is it a shocker that there are more than 83 million people in the US living in areas with scarce primary care physician access, and there might be a shortfall of up to 124,000 physicians by all specialties by 2034 (LINK: ), according to the Association of American Medical Colleges?No.
Is it surprising that the rural US has it worse with respect to that shortage? And ditto for poor/urban centers and regions with predominantly brown/black Americans?
So are we seeing President Biden, and did his predecessors, do the right thing with respect to funding more health plan coverage and affordable medications, but also sufficient numbers of health care providers and nurses?
Did the Affordable Care Act, and any attempts to replace it, have any real representation of doctors in its derivation and implementation?
So here are a few ideas, if we’ve got the smarts and spines, to help address this shortfall:
1) Repurpose law schools into medical schools. There are a approximately 200 law schools in the United States, while there are only approximately 170 MD or DO medical schools.
2) For those of us still living in the Stone Age, MD’s and DO’s have similar educations, although some traditional “MD” residencies (which have no shortage of DO’s attending them) are too often of different competency levels compared to “DO” residencies. In short, they’re both awesome groups of doctors, and those programs are already combining.
3) The Perfect is the Enemy of the Good, Part #1: This will be a bit controversial, but Board-Certification, re-testing, and clinical equivalence between different residency programs is essential to ensuring that all physicians, MD or DO, are of superior and equivalent excellence. But we all need to work like hell (with governmental support) to that end.
4) The Perfect is the Enemy of the Good, Part #2: Also a bit controversial, but we better figure out that a LOT of Nurse Practitioners are pretty darned awesome, and maybe smarter, kinder, and more effective than a lot of high-and-mighty doctors. We need a whole lot more of them, and with a focus on overseeing physicians whenever possible.
5) The Perfect is the Enemy of the Good, Part #3: Still more controversial, despite Nurse Practitioners being PRACTIONERS, we have those Physician Assistants who will never be more than Assistants, but others who behave like Physician Associates (in other words, like quasi-doctors). The latter group is really smart…and underappreciated…
…and many of them, with proper testing and certification, can be specialists or even considered for medical school. Right now, in fact.
6) A generation ago, we had RN’s become more supervisorial than just “rooming patients”, with LVN’s (Licensed Vocational Nurses) and now MA’s (Medical Assistants) doing the rooming and day to day activities. Now we will need to have more MD’s and DO’s do the training and overseeing administrative/executive functions over PA’s and NP’s…
…and those who oversee Physician Extenders (NP’s and PA’s) must be paid a LOT better than those who don’t, because they’ll be taking care of—directly and indirectly—a lot more patients. Not sure if medical schools/programs address THAT career path.
7) Too many graduating physicians want “the good life” or the “work/life balance” that leads to a 3-4 day workweeks (excluding 12-hour shifts), and leads to an underperforming physician work force. It’s NOT sexist, classist, elitist, or any other “ist” to suggest that large employing medical groups should attract and hire a lot more for those who work 40 hours a week or more…
…and while it’s not criminal for those working 30 hours or less, the societal emphasis on working 40 hours a week (or more) when one is a doctor/physician must be highlighted, revered, and lionized. And for those PA’s and NP’s picking up the slack, they need to be paid more…much more!
8) We need to bring back the subsidizing programs from yesteryear, whereby medical school loans would be repaid by sweat equity—to get your four years of medical school paid for, then they’d need to work 2-4 years on Native American reservations or in urban regions where doctors are few…and they’d be paid only resident physician salaries…or less.
9) Why are we making it so damned difficult to get into medical school with excellent scores if one is (gasp!) white or (double gasp!) from East Asia or South Asia? Get over the reverse racism, recruit more physicians from all ethnicities, and fix the doctor gap!
10) Similarly, why do we have all these nonsensical “gap years” when we need physicians ASAP to replace the hordes of retiring and quitting physicians who are fleeing electronic medical records, bureaucratic nonsense, and COVID-burnout? Get ‘em in, get ‘em trained, and get ‘em out there treating patients!
We have tons of physician-ready Americans who NEED to join our physician workforce (probably the same can be said for nurses of all levels, by the way). Some of them are college students. Some of them are PA’s and NP’s. And some of them might be YOU, reading this now.
The physician/provider workforce is too small, and too encumbered with silly and nonsensical obstacles to be enlarged to meet our nation’s health needs. This is absolutely fixable, or at least in very large part fixable, over the next 5-7 years.
But do we have the political and societal will to fix this shortfall?
(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. He was active for 20 years on the Mar Vista Community Council (MVCC) as a Board Member focused on Planning and Transportation, and helped lead the grassroots efforts of the Expo Line as well as connecting LAX to MetroRail. 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.)