Physician shortage

Healthier lifestyles, changes in care will help

Perhaps it should come as no surprise that this country is facing a shortage of doctors. People in their later years require more medical attention than do those who are younger, which has not changed, and one-third of doctors are older than 55, according to a recent New York Times story.

And while medical schools continue to produce doctors at about the same rate as previously, the Patient Protection and Affordable Care Act will make it possible for more people to access health care as they should, in progression as they need it, not when it becomes a crisis and only the emergency room is available.

In some parts of the country, where population has grown and a doctor’s lifestyle less appealing, the ratio of doctors to population is already wildly out of whack, according to the Times’ story on Sunday. Southern and the interior of Southern California, the South and in a couple of large cities in the North are cited. Instead of 60 to 80 primary-care doctors per 100,000 people, the ratio is half that in some areas.

In all, some 45,000 additional primary-care doctors are needed in the country, according to the Times. So, too, will more specialists be needed.

The answers to what to do about the growing shortage are several, and the Times touches on several. Expect more health care to be delivered at the clinic level, and by lower-level generalists and specialists, such as nurses, who are trained and permitted to play larger roles. And doctors may work in teams for efficiency.

It is also not impossible to imagine a healthier citizenry, perhaps over a longer period of time – a citizenry that eats more properly and exercises to the point that less health-care intervention is required until very near the end of life. And, most importantly, we can imagine a shift in culture that makes it more acceptable to say “no” to those excessive end-of-life treatments that buy a few weeks or a couple of months of questionable “life” at an excruciating cost in resources for everyone involved.

But that the number of doctors needed in this country will fall increasingly short is no reason not to extend insurance to as many people as possible. Adequate insurance is being shown to result in better health care and thus healthier, more productive lives.

For young people uncertain of a career, there is good reason to suggest the many levels of health-care delivery and research. And for those who will need care – everyone to different degrees – there is good reason to make the kinds of lifestyle decisions that will reduce that need to the lowest possible amount.

Here is to more doctors, and to less need for them.