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  • JAMA Forum: BITWMA

      11/27/2013
      Aaron Carroll

    I’m off to see family for Thanksgiving. But I left you a piece in The JAMA Forum to read. “OECD Report Offers a Contrast in Perception vs Reality in US Health Care“.

    Go read!

    @aaronecarroll

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      Health Policy
      OECD, quality, spending
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    • Comments (10)

    • by Floccina on November 27th, 2013 at 16:29

      The US health care workforce is small, ranked 28th in the number of physicians per population and 29th in the production of medical graduates.

      Since there are many that would like to be MD’s but cannot get licensed, this sounds like a problems that could be improved by easing up on license requirements.

      [top]
      • by Mark Spohr on November 28th, 2013 at 11:38

        Floccina… do you really want a poorly trained doctor?

        [top]
        • by Floccina on November 28th, 2013 at 14:06

          Mark please define poorly trained.

          I know people who could not get into medical school who I think would make great MD’s. I know people who have practiced outside the USA who cannot get licensed here who I would go to.

          And by the way, this is why doctor is such an unappealing profession in France. Since I’ve been thinking about this, I’ve gone through my memory and been struck by how, when I was in school, nobody asked if I wanted to be a doctor. As I understand it, the cliché is that a bright young middle-class kid will become “a lawyer or a doctor.” In my upper-middle-class background, no one even brought up the idea that I might want to be a doctor. Lawyer? Sure. Bureaucrat? Of course. Business executive? Why not.

          Medical interns in France make less than the minimum wage per month (and therefore much, much less per hour) so if you want to become a doctor you had better have parents who can afford to support you into your late twenties. In the fancy prep school I attended, the only pupils who were thinking about becoming a doctor had a doctor parent. This completely scientific survey of some people I vaguely knew over a decade ago leads me to speculate that becoming a doctor in France has become sort of like contemplating a military career in both countries: a profession you might choose because of prestige/family tradition/passion but that has stopped being a smart financial bet and so draws on an increasingly narrow pool of applicants. Which is quite worrisome from a societal perspective when you think about it.

          If the above is correct I assume that MD’s are less likely to come from as great a set of students in the USA and yet they do fine.

          IMHO it is not so much the brilliance of the MD that matters but the systems.

          BTW I had a very minor operation done in Honduras where it is much easier to get into medical school.

          Something med school in Cuba:

          The Latin American School of Medicine is a six-year program of study, which includes two years of basic sciences, three years of classwork and clinical rotations at accredited teaching hospitals, and a rotatory clinical internship in the sixth year. All classes are taught in Spanish; but a semester-long Spanish language intensive is offered to students who need it (prior to first year), along with a pre-med semester in which students can review pre-med sciences and improve their fluency in Spanish. All students study at the LASM campus for the first two years, and then go to another of Cuba’s 21 medical schools, which are located throughout the island, to complete their studies.

          [top]
          • by Ken Hamer on November 28th, 2013 at 23:45

            “And by the way, this is why doctor is such an unappealing
            profession in France.” Seriously? You’re quoting from a guy who
            admits, repeatedly, that he doesn’t really know anything about the
            French health care system, or even health care in general: “I want
            to make clear that I have no particular expertise when it comes to
            healthcare policy” “as I understand it from living here (and I may
            be wrong about this because it gives me migraines)” “a system
            similar to (I think?) Medicaid” “From my understanding” “Again, I
            don’t really understand how most of this works,” “After mulling
            this on and off for many months since I’ve been thinking about
            this, I think the defining thing is…” “All of this is a
            roundabout way of saying that my neophyte impression is that the
            French and US healthcare systems…” And the *real* reason US
            health care costs are so high: “the US is thereby subsidizing the
            rest of the world’s healthcare costs.” That’s not evidence. It’s
            not data. It’s not even an anecdote. It’s gossip. I’d call him a
            moron except that it would be an insult to morons.

            [top]
            • by Floccina on December 2nd, 2013 at 14:21

              OK replace the French stuff with this:

              Again a deafening silence. Dozens of studies over decades consistently find no patient health differences between expensive docs and cheaper clinicians, but there is zero momentum to let clinicians replace docs – policy trends go the other way. The “establishment” complains about flaws in existing studies, but feels no need to do better studies. What is the point of social science if even relatively clear important results are ignored?

              [top]
          • by SteveH on December 2nd, 2013 at 17:01

            “And by the way, this is why doctor is such an unappealing profession in France.”

            It’s so unappealing that the supply of physicians in France is only 33% greater per 1,000 people than it is in the USA!

            [top]
        • by MV on November 28th, 2013 at 15:38

          First, I would submit that we already have poorly trained doctors. I’ve run into a more than a few as a patient. However, I don’t think that’s a problem with the training requirements. It’s a fact of life in any profession.

          However, we have already eased up on license requirements in many states. If naturopaths can treat patients, I would submit that their are really no significant standards at all.

          Perhaps we should have fewer artificial restrictions and more reality based ones. For instance, do you (or can you) practice science based medicine versus magic based….

          [top]
        • by David J. Littleboy on November 28th, 2013 at 19:39

          Really.

          I’d much rather see eased entrance requirements to medical school and larger med school class sizes*. And more financial aid for med school of the type that can be repaid by working in less-well serviced communities, so the docs can stop complaining about their debt load.

          This latter bit is important, since if we’re going to get costs down to Japan’s level, charges for medical services will have to be regulated, and that’s going to cut doctors’ salaries.

          *: In my opinion, medical schools are so competitive for admission that they could double in size and not see any loss in quality. Sure, if they doubled in size, they’d slightly more than double the number of dropouts and problematic doctors, but I bet the number of truly good doctors, doctors who do the scientifically interesting and socially useful things, would more than double.

          [top]
          • by Tyler on November 29th, 2013 at 01:02

            As a family physician for > 30 yrs., I could go on
            for pages about the sloppiness I see every week in the care that my
            patients get in our current pathetic health care non-system.
            Sometimes they are aware of it, and sometimes I pick it up in the
            records I receive. I’m amazed at how much people have come to
            expect sloppiness, mistakes, indifference, disrespect, long waits,
            etc. I’m absolutely convinced that doubling the number of people
            accepted into medical school would not harm the quality of care
            delivered in the US, since only bright students even bother to
            apply to medical schools, and the large majority are not accepted.
            Additionally, I believe that MCATscores and GPAs are poor
            predictors of who will prove to be the most dedicated,
            knowledgeable and caring physicians. Doubling the output of
            physicians over the next 10 years would: a) greatly increase the
            care options available in inner cities, rural areas, VA
            hospitals/clinics, health depts., and community health centers. b)
            actually make it possible to provide comprehensive and ongoing care
            to the large number of people that we (seem to) want, as a nation,
            to ensure have decent health care, c) put substantial competitive
            pressure on all Providers to up their game, giving much higher
            quality care than is currently passable, d) cost the nation a
            considerable amount of money in medical school subsidies, but reap
            rewards that would easily justify that cost. e) reduce wait times
            for appointments that we all experience.

            [top]
    • by Ryan on November 29th, 2013 at 10:27

      Why not just let trained non-MDs give more care? Other than
      greedy MDs who is going to be upset by this?

      [top]

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