Among the complicated health care problems currently facing the nation, and thus requiring reform, is one relatively straightforward problem: There aren’t enough primary care physicians.
Primary care physicians are your basic cookie-cutter doctors. They graduate with a medical degree and complete the requisite training to get licensed in a particular state, without necessarily any particular specialization. They cover all of your basic medical needs and are the first ones you see if there is a problem. While they are in the highest demand, they also get paid the least among doctors, making nearly half of what specialists do.
Now, consider that these primary care physicians are more or less required to complete a four-year bachelor’s degree, then a four-year medical degree, and then a minimum of one to three years of clinical training. That’s at least nine to eleven years, and they’re still at the bottom of their profession—below the specialists, who go through even more clinical training. Add onto that decade of rigorous tutelage an average of at least $150,000 of debt and you have a truly unpleasant stretch of life that must be knowingly swallowed by 18-year-olds.
Is it any big surprise then that there is a shortage of primary care physicians?
Doctor Shortage Solutions
In a town hall meeting last month, President Obama acknowledged, “If you look at the makeup of the medical profession right now … we have severe shortages of primary care physicians.”
The solution he suggested was to give primary care physicians additional incentive pay. For a profession that already makes an average of $150,000 a year, it may be hard to get such incentives, paid for with taxpayer dollars, past congress.
A better idea, floated by officials in Obama’s administration, would allow nurse practitioners and physician assistants to carry out some of the same functions as primary care physicians.
Even though nurses and others are qualified to carry out many of the same functions as primary care physicians, they are restricted by state-based medical boards who limit their “scope of practice,” as it’s known in health industry lingo. Essentially, these boards’ scope of practice rules keep nurses from offering the same services as doctors at a lower cost. And, of course, these boards themselves are controlled by doctors. Sound fishy? It is.
Expanding the powers of nurse practitioners and physician assistants is a good start. But the Obama administration should also aggressively push a reduction in the number of years required to earn a Doctor of Medicine (MD) degree and get a student into the professional field.
In the future, an aspiring nurse could decide to put in a little more effort and, instead of getting a four-year bachelor’s degree in Nursing, get a five-year MD. As strange as it might sound, most of the world is already doing it.
Instead of taking about 10 years to get a doctor on the street, our neighbors in the United Kingdom get their equivalent of the primary care physician in just five years. After high school, students in the United Kingdom, and other commonwealth countries like Australia, New Zealand, and India, enter directly into five- or six-year programs leading to a degree known as a Bachelor of Medicine and Bachelor of Surgery Degree (MBBS).
These MBBS programs skip over liberal arts curricula and majors and cut straight to a medical curriculum and clinical training, producing students able to enter directly into the medical field.
The law of supply and demand would ensure that as more 23-year-olds become doctors, medical fees would come down, as would the doctors’ student debt. Combine that with reduced restrictions on the services that qualified nurse practitioners and physician assistants can and cannot provide, and health care prices would undoubtedly drop down.
The downside to a five-year MD—for whoever might care—is a goodbye to American doctors with liberal arts educations. No longer will your primary care physician have studied introductory topics in sociology and philosophy; no longer will your physician have a vague memory of Spanish grammar; and no longer will your physician know how to use a graphing calculator.
Seems like a fair sacrifice for more doctors.
