The AARP Bulletin has a article this month by Howard Zucker that makes me want to tear something up and scream. It documents the bad trends in our the number of doctors in our nation and how they are used and treated. Short summary: our system is screwed and so are we, and it is only going to get worse, assuming no changes and there is little reason to expect any. Here is the link, although you may have to register:
Where have all the doctors gone?
Some key excerpts:
“The backbone of our health care system, private practice, is on the brink of collapse,” warns Clarel Antoine, M.D., professor of obstetrics and gynecology at New York City’s NYU Grossman School of Medicine. “As a result, the nearly 70 million Americans on Medicare, many with chronic conditions, can expect longer waiting times for medical care.”
Why don’t we have enough doctors?
In 1980, a U.S. government report concluded that American teaching hospitals were graduating too many medical students. It predicted a surplus of 70,000 physicians by 1990, an alarming statistic. In response, medical schools established what became a 25-year moratorium on increasing class size, enforced by the AAMC and the American Medical Association (AMA).
Yet there was a significant flaw to that initial report: It failed to account for the nation’s rising population, which is now 110 million more than it was 45 years ago.
And how are they forced to use their time?
In reporting this story, I spoke with dozens of physicians, the vast majority of whom vented their frustrations with the current state of medicine. But just as tellingly, almost all of them also refused to talk to me on the record, fearing that speaking out could cost them their jobs.
Part of what’s driving this is the growing trend of private equity firms and corporations, such as CVS Health and Amazon, purchasing hospitals and private practices. One major medical group, with about 90,000 doctors in some 2,000 locations across the country, has spent billions of dollars acquiring physician-owned practices, home health centers and surgical centers. This past April, the Physician Advocacy Institute reported that just shy of 80 percent of all doctors were employed by hospitals or corporations, up 200 percent in just over 10 years.
Typically, when for-profit firms acquire practices, they approach these acquisitions utilizing a profit-based strategy. What does that look like?
The doctors I spoke with off the record explained that corporate entities now govern their allotted time with patients, often allowing just 15 minutes per visit, a situation that isn’t healthy for either the doctor or the patient. “They control every aspect of a doctor’s professional life, and it’s all about the money,” one doctor told me. A 2024 JAMA Internal Medicine report said that 61 percent of doctors surveyed found private equity ownership unfavorable for health care.
And then there’s the paperwork. For every hour seeing patients, the average doctor now spends two hours doing administrative tasks, according to the AMA. A primary driver of paperwork: the electronic health record, or EHR.
“The EHR is the bane of existence for every doctor in the country,” says Opole. The EHR was designed to eliminate a paper-based tracking system and make patients’ health records easier for various health professionals to access. But in practice, doctors say, its primary focus is documenting for regulators and billing for insurers. To handle rising administrative demands, doctors have begun cutting back on office hours, resulting in even less time available to see patients. A 2023 Mayo Clinic study noted that 40 percent of doctors it surveyed intended to reduce their work hours in the coming 12 months.
Finally, it ain’t getting any better:
“There is a perfect storm coming,” says Bruce Scott, M.D., president of the AMA, “with increased patient complexity, decreased reimbursements and increased demand for prior authorizations from the insurance company. The combination of these makes it increasingly difficult for physicians to accept new patients and, in some cases, even keep their doors open. We can’t afford to lose even one more doctor.”
Whoo-hoo, max profits come to healthcare!!!! Donchya love it! Invest now and maybe you too will be able to afford a concierge doctor. Private equity is just so fucking horrible, yet not a peep from the halls of Congress. It is also affecting veterinarian care and even ski resorts. Hey, maybe if Canada becomes our 51st state I can get commie care from them.