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Spokane, Washington  Est. May 19, 1883
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Opinion >  Syndicated columns

Smart Bombs: Doctor shortage isn’t new

It’s interesting to watch a new policy take the blame for a long-developing problem. The doctor shortage is gaining attention now that the Affordable Care Act is the law of the land. But this is like blaming cancer on your last cigarette.

Nonetheless, pundits and politicians are weighing in with the haughty observation that while the newly insured will gain an insurance card, they won’t necessarily see a doctor. Oh, look at the silly people thinking they have health care now.

This wouldn’t be so obnoxious if they actually cared about the uninsured. No, their concern is that reform might cause them to spend more time in the waiting room with the hoi polloi, or have less time to compare golf scores once they get in.

Oddly, the doctor shortage is never mentioned when politicians talk about “common sense” replacements for “Obamacare.” Wider access is the alleged goal of tort reform, selling insurance across lines and other free market “skin in the game” schemes. So, how will we find enough doctors to handle these new patients delivered from the loins of Ayn Rand?

If they don’t suddenly materialize, should we forget Republican reforms, too?

A second opinion. The shortage of doctors is a real problem, and it has a fascinating history. Last year, Remapping Debate, a terrific website featuring in-depth reporting, investigated the severity and origins of the shortage. Some points to consider:

• In 2006, there were no surgeons in 30 percent of U.S. counties.

• In 2007, the United States had 243 physicians per 100,000 people. The international average for modern nations was 298.

• Since 2005, appointment wait times have gotten longer, even in areas with high physician-to-patient ratios.

• In the next decade, the United States will need anywhere from 90,000 to 200,000 more doctors to offset the coming wave of retirements among older doctors.

All of the above were true before the adoption of the Affordable Care Act.

The state of Washington has been tracking the health care worker shortage since 2003. In its annual report for 2011, a task force commissioned by the Legislature found that the recession had eased the problem temporarily. But it will return, especially since more people will have insurance and the elderly are living longer.

The report also notes the chronic shortage of residency slots. Graduate medical education is expensive, and no matter how many students are pushed through medical school, the residency logjam serves as a cap on physician supply.

This problem is longstanding. As the Remapping Debate article notes, Medicare is the primary financier of residency slots. As part of the 1997 Balanced Budget Act, the number of slots was capped at 100,000, and it’s stayed that way ever since. However, the U.S. population has grown. Remember the Gingrich-Clinton debates about whether Congress was cutting Medicare? Well, this spending cap created the logjam that created the doctor shortage.

Before 1997, there were impassioned debates about the supply of doctors. In answer to a feared shortage, Congress passed legislation in 1963 that more than doubled medical school enrollments in the 1960s and 1970s. This expansion was halted in the 1980s by reports of a looming oversupply of doctors. That consensus eventually cracked, but budget concerns have prevented supply from meeting demand ever since.

Even if we could find the money tomorrow, it would take a couple of decades to produce a sufficient supply of doctors. That’s because the roots of the problem run far deeper than the passage of the Affordable Care Act.

Er, what? From the Associated Press: “Former Republican U.S. Sen. Larry Craig aims to scuttle federal campaign charges against him by arguing his infamous July 11, 2007, Minneapolis airport bathroom visit that ended in his sex-sting arrest was part of his official Senate business.”

Is he serious, or is this just a stall tactic?

Associate Editor Gary Crooks can be reached at or (509) 459-5026. Follow him on Twitter @GaryCrooks.
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