紐約時報:美國現在缺醫生，請英文"很好"，又有"國際觀"的波醫趕快去(若學歷在美國真無問題)

[梅花鹿]

http://www.nytimes.com/2009/04/27/healt ... &th&emc=th

Shortage of Doctors an Obstacle to Obama Goals

By ROBERT PEAR
Published: April 26, 2009

WASHINGTON — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Obama’s goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada.

Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”

Even people with insurance have problems finding doctors.

Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.”

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease.

“Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists.

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way.

“If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year.

“If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older,” said Dr. Atul Grover, the chief lobbyist for the association. “Let’s say we insure everyone. What next? We won’t be able to take care of all those people overnight.”

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.

“Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.

The ratio of primary care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs.

“It’s completely reasonable to say that adding more physicians to the work force is likely to increase health spending,” Dr. Grover said.

But he said: “We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary.”

In many parts of the country, specialists are also in short supply.

Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.

“It’s a long, exhausting drive, three hours down and three hours back,” Ms. Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers.

But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.

(A version of this article appeared in print on April 27, 2009, on page A1 of the New York edition.)

[梅花鹿]

波醫怎都不見了
可能中文變較強(網戰)，英文...

[梅花鹿]

找ㄧ些紐時上美國人的回應，以供參考

希望波醫加把勁，拿出你們傲人的"實力"

EDITORS' SELECTIONS
April 27, 2009 8:18 am

Most of the readers here just don't get it at all, and neither does Obama.

As a recruiter in the medical world (let me make it clear, I am not a physician), there are no easy or quick fixes to this problem. And medical care in the US is going to be rationed just by the fact that we don't have enough doctors.

But a few comments:

* Why would anyone want to "lower the standards" for people to get into medical stanards. Our educational standards are pretty low already, and I don't think I want the "mediocre" student doing open heart surgery on me, thank you very much.

* 25% of our physicians are IMGs (International Medical Graduates), they are already here due to the supply/demand issue.

* It will take many years to increase the flow of more doctors into the system - so if we instituted health coverage for all anytime soon - well, get in line to get an appt. (And just ask anyone who lives in MA about this).

* Primary care doctors make, on average, about $150K a year and I know many who make much less than that but typically work 60-80 hours a week. Sub-specialists, depending on the specialty, can make 4-5 times that much. Which area would you chose to go into?

* Medical malpractice insurance rates drive the costs up for doctors. Until Congress deals with the trial lawyers, costs will continue to spiral and we all will have to pay for it.

* The big bottleneck in medical education is resident and fellowship training. You can open the medical schools all you want to but until you address adding more places for this training, the numbers of doctors will not increase. This is not being addressed.

Estimates are that we have a shortage of physicians by 2025 in the range of 150,000 to 250,000 physicians. Get in line and hope that you don't get sick.
— Anita, Brownsburg, VA

[咖大]

人家波波可是有國際觀的
現在紐約快被豬流感攻克
人家不去

[梅花鹿]

人家波波可是有國際觀的
現在紐約快被豬流感攻克
人家不去

多謝咖大捧場

不過波波既有國際觀，應也有前瞻觀

豬流感是一時的，神醫崇高的濟世救人的醫德怎容此小小障礙擊潰

[梅花鹿]

其中一篇回應是基層醫師寫的

看來美國基層醫師的paper work不會比我們少到那去


EDITORS' SELECTIONS
April 27, 2009 6:00 pm

Just having finished my first continuous 6 hour clinic of the day I don't have time to read the other 503 posts. So, I apologize if someone else has pointed this out: the statistics are worse than they look. I am a primary care, board certified Internal Medicine doctor and it has been years since I have seen even one of the residents who graduate from our internal medicine residency program going into primary care. Many, though, have not specialized. They have simply become "hospitalists". Doctors who care exclusively for hospitalized patients and work set shifts. This is a trade off, for the newly minted MD: On the one hand they continue to do the difficult and intense management of the very ill, often late into the night. On the other hand they do not deal, in any substantive way, with the on-going management of complex, multiple chronic illnesses and the attendant mountains of paper work that accompany most general medicine outpatients. The choice is clear. Though hospitalist work may be harsh, frustrating and intense, at least it ends at the end of the shift. Primary care is harsh, frustrating and intense and it does not end. It expands to fill the available space. I fear that if the Obama administration somehow engineers an additional 5000 medical school graduates a year, then 4950 will be divided among cosmetic surgeons, ophthalmologists, dermatologists, radiologists and anesthesiologists. And the remaining 50? Say hello to 50 new hospitalists. (I should also mention that the pay for a first year hospitalist is significantly higher than that for a primary care generalist.)
— Jim Lax, jamlac

[braveheart8149]

波醫怎都不見了
可能中文變較強(網戰)，英文...

人家不是不見了，是有人下指導棋。

不用來這兒辯，人家現在可能集合火力在遊說立委吧~

[梅花鹿]

波醫怎都不見了
可能中文變較強(網戰)，英文...

人家不是不見了，是有人下指導棋。

不用來這兒辯，人家現在可能集合火力在遊說立委吧~

可是還有幫腔的數X老師，代辦的奶蛋白先生...

可能是看不太懂...

(我故意提高門檻ㄧ下咩... )

[herotopone]

波醫们趕快去美國吧

[X-MAN]

這些文章主要敘述美國缺乏PRIMARY CARE PHYSICAIN,有些地方已經到無法忍受地步.造成缺乏原因是給付過低,工作量大與無止盡責任.因此大部分醫生選擇專科醫師或是HOSPITAL-BASED 醫師.

其中壹種解決方法醞釀中,是資源重分配(醫師中PRIMARY 與SUBSPECIALTY之間).引發國會遊說之戰.

這與波蘭應沒關係吧?

[梅花鹿]

呵呵...
當然無關囉
感謝X-MAN大還幫我們summarize得很仔細
(偽可愛) (偽可愛) (偽可愛)

[金生麗水]