jmj11 Posted May 30, 2014 Share Posted May 30, 2014 I attended a Washington State Heath Care Innovation seminar (telecast) last night. One new thing I learned is that the primary care shortage that we will and are facing was intentional. According to the presenters, CMS (and Congress) were seeking ways to reduce the cost of Medicare and Medicaid. In 1987, they put in a policy that limited medical school admissions (set a quota). Their thinking at the time was that since most claims coming into Medicare and Medicaid were generated from physicians . . . that if you reduce the number of physicians . . . you would reduce the number of claims and save money. Seems a little kindergartenish. I also saw a study that was presented (I think I've seen this before) that in Oregon at least, the uninsured had much better health care than if they went on Medicaid. In the seminar, "midlevels" were mentioned once as part of the solution. Link to comment Share on other sites More sharing options...
andersenpa Posted May 30, 2014 Share Posted May 30, 2014 Fascinating Do you have a link or any thing like that? Link to comment Share on other sites More sharing options...
whoRyou Posted May 30, 2014 Share Posted May 30, 2014 Yes, I must admit you have piqued my interest as well. Anything you can share would be appreciated. TY BTW while doing my own research on this particular topic I found this if anyone is interested (Note it was written 7 years ago). Things like this make you go hmm ... http://www.managedcaremag.com/archives/0706/0706.shortage.html Link to comment Share on other sites More sharing options...
G. Davenport Posted May 30, 2014 Share Posted May 30, 2014 It's all propaganda (in support of a view) until the research and motive behind the decision is exposed. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
coloradopa Posted May 30, 2014 Share Posted May 30, 2014 I attended a Washington State Heath Care Innovation seminar (telecast) last night. One new thing I learned is that the primary care shortage that we will and are facing was intentional. According to the presenters, CMS (and Congress) were seeking ways to reduce the cost of Medicare and Medicaid. In 1987, they put in a policy that limited medical school admissions (set a quota). Their thinking at the time was that since most claims coming into Medicare and Medicaid were generated from physicians . . . that if you reduce the number of physicians . . . you would reduce the number of claims and save money. Seems a little kindergartenish. I also saw a study that was presented (I think I've seen this before) that in Oregon at least, the uninsured had much better health care than if they went on Medicaid. In the seminar, "midlevels" were mentioned once as part of the solution. Congress can't limit the number of med school admissions. They have nothing to do with med school admissions. What congress did in 1985 was limit the number of overall resident slots paid for by Medicare. So they can limit the number of physicians produced. If they really wanted to they could increase the number of primary care slots and decrease specialist slots. Overall it was to limit medicare spending. Since Medicare is a zero sum game its unlikely that there will be more slots opening any time soon. Link to comment Share on other sites More sharing options...
whoRyou Posted May 31, 2014 Share Posted May 31, 2014 ^^^ Now you also have caught my attention, is it possible you have some literature or something more on this? Link to comment Share on other sites More sharing options...
jmj11 Posted May 31, 2014 Author Share Posted May 31, 2014 Here is the seminar. To hear how it was stated, go to minute 32:40 of the broadcast. Coloradopa, you are probably correct, but you can hear how the program leader expressed it . . . as medical school enrollee limit. Link to comment Share on other sites More sharing options...
whoRyou Posted May 31, 2014 Share Posted May 31, 2014 ^^^ JMJ - Link to comment Share on other sites More sharing options...
cbrsmurf Posted June 3, 2014 Share Posted June 3, 2014 Med school admissions aren't limited. Residencies are, however. And family practice and primary care residencies aren't usually completely filled. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 3, 2014 Moderator Share Posted June 3, 2014 Med school admissions aren't limited. Residencies are, however. And family practice and primary care residencies aren't usually completely filled. I'm pretty sure this has changed. lots of folks list FP as their fallback in the match if they don't get what they really want to avoid being in a no residency situation. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 3, 2014 Moderator Share Posted June 3, 2014 it all comes back to supply and demand (yes this one idea is one of the driving forces behind the business of health care) Physician Agencies want to keep the supply limited, then the demand stays high, and they can charge outrageous prices for their services. Sure sort of benefits PAs as well, but I think they have underestimated the ability of PA and NP to step right into PCP world and do it...... Did you know Blue Shield of CA - the first major insurance co - was started by physicians did you know that up to HMO and managed care in the 90's physicians freely set their charges and they mandated that the insurance company paid their silly high prices. Did you know that managed care came about due to the problems with physicians setting their own reimbursement and it was the industries/countries, way of fighting back. when Supply < Demand you can inflate your price It is simple business model that is exceptionally effective and protected due to the whole "Physician is top of the pile" mentality and that no one else could possibly do what a MD/DO does........ Man do we need to get out from under this system!! Link to comment Share on other sites More sharing options...
whoRyou Posted June 4, 2014 Share Posted June 4, 2014 Med school admissions aren't limited. Residencies are, however. And family practice and primary care residencies aren't usually completely filled. I'm pretty sure this has changed. lots of folks list FP as their fallback in the match if they don't get what they really want to avoid being in a no residency situation. I find these two statements interesting ... Link to comment Share on other sites More sharing options...
coloradopa Posted June 4, 2014 Share Posted June 4, 2014 Med school admissions aren't limited. Residencies are, however. And family practice and primary care residencies aren't usually completely filled. IM and Peds 96%. FP filled 96%. 1000 positions that didn't fill were filled within a few rounds in the SOAP. In the end 106 of 29,671 positions went unfilled and they were most likely filled outside of the match. http://www.nrmp.org/wp-content/uploads/2014/03/2014-National-Resident-Matching-Program-NRMP-Main-Residency-Match-Results-Press-Release.pdf Link to comment Share on other sites More sharing options...
primadonna22274 Posted June 4, 2014 Share Posted June 4, 2014 Thank you David. I wanted to respond but didn't have the stats immediately available to back me up. Ironically, 2014 was THE MOST competitive for FM in many years. Interesting sea change.... Link to comment Share on other sites More sharing options...
SocialMedicine Posted June 4, 2014 Share Posted June 4, 2014 too bad congress cannot limit PA schools. Just heard ANOTHER new program in the tristate area. At another university without a medical school or quality health sciences program. I bet they will have a huge challenge finding faculty and clinical locations that produce quality PA's. Has anyone looked at the data of success in students from these new PA schools ? Just looked at the PANCE fail rates of several programs ... VERY LOW Link to comment Share on other sites More sharing options...
SocialMedicine Posted June 4, 2014 Share Posted June 4, 2014 also I do not find anything wrong with limiting the number of providers to some extent ? I have a utilitarian view here. if medicine does not pay high smart people will not work in the field. I have 0 doubt I could walk into healthcare pharma consulting and earn 150 in a few years. Medicine is my passion but if it does not pay me at least 6 figures I am out. We invest so much into this trade ... constant learning ... liability concerns ... on call hassles. There is much more than monetary value when a patient gets healthy by your efforts. But that's not paying for the sacrifice of a career an dedication in medicine. I wonder what the health outcomes, costs, and wait times would be with a sub par but more abundant medical workforce? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2014 Moderator Share Posted June 4, 2014 the rapidly increasing # of new programs means anyone with 3-4 years experience as a pa can get a job as faculty . also you will be in much higher demand if you have taught previously or precepted students. a masters degree or doctorate make you even more employable. Someone offered me an associate program director position at a new program unsolicited at the conference in boston, even before completion of my doctorate. there are lots of hungry program directors out there looking for faculty. Link to comment Share on other sites More sharing options...
G. Davenport Posted June 4, 2014 Share Posted June 4, 2014 Just curious EMEDPA, why didn't you take the job? That doctorate don't impact your practice. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 4, 2014 Moderator Share Posted June 4, 2014 Just curious EMEDPA, why didn't you take the job? That doctorate don't impact your practice. Sent from my iPhone using Tapatalk the new program is in a place my wife would never agree to move to. Link to comment Share on other sites More sharing options...
roombroker03 Posted September 4, 2014 Share Posted September 4, 2014 With this alone, you can determine how important it is for people to recognize where the nearest medical capability is. It's better to be watchful than to feel sorry in the end. http://www.Emergencyroombroker.com Link to comment Share on other sites More sharing options...
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