“The physician shortage that we have long feared—and warned was on the horizon—is here. It’s an urgent crisis hitting every corner of this country—urban, rural—with the most direct impact hitting families with high needs and limited means. Imagine walking into an emergency room in your moment of crisis, in desperate need of a physician’s care, and finding no one there to take care of you. That’s what we are up against.” AMA president Jesse Ehrenfeld MD.
I recently spent a very long night and morning in an emergency room near me. The rooms were all filled with people waiting to be seen and treated. There must have been over a hundred people there, most looking miserable, sick, or injured. I was asked to leave my family member behind, as due to overcrowding no family members were allowed. (I came back later anyway. ) It took 8 hours for my family member to be seen, and another 5 until she was released with instructions. In the meantime we waited while hospital staff performed triage and vitals checks to make sure no one died while waiting. When asked how long it would be, they admitted they had no idea.
13 hours may not be the average for emergency room waits, but it's likely not an outlier either. I've since heard from folks that waited up to 24 hours for treatment. The doctor shortage is real and it's obvious from looking at one of the first points of contact- the emergency room. My doctor recently announced that he was retiring. Many more have been joining him, burned out by insurance company red tape, lower Medicare and Medicaid reimbursements, and grinding work schedules with sicker and sicker patients. The few good doctors that are left are setting up concierge services for wealthy people who can afford to pay large annual fees and expensive testing not always covered by insurance. That leaves the rest of us to try our luck finding anyone in our time of desperation.
This American healthcare system is bad, and it's about to get a lot worse. At a time when there will be more senior citizens than ever before, requiring more and more medical attention, there is a growing shortage of doctors. (and nurses!) At a time when healthcare if becoming more and more unaffordable, America's political shift rightward is almost sure to cut funds from social programs like Medicare, Medicaid, and the Affordable Care Act. This perfect storm will cause millions of Americans to put off preventative and routine care, almost certainly landing them in the one place that has to take them- the emergency room. Just be prepared to wait a long, long, long, long time to get seen if you can survive that long.
So why the doctor shortage? Why are nearly one in four US doctors now coming from other countries? There are many causes. The main one seems to be the limits placed on residency positions- training essential to becoming a physician. The American Medical Association lobbied for a long time to cap the number of residency positions to minimize competition and maximize doctor salaries. Recently the AMA has realized that this position caused a shortage of trained doctors and reversed itself. But the damage has been done, and it will take an act of a very dysfunctional congress to expand the residency positions through Medicare funding.
Other causes include antivax conspiracies, insurance companies, physician burnout, Medicare reimbursement problems, and the exorbitant cost of medical school ($60,000 per year for four years!) Medicine has always been seen as one of the most revered and high-status occupations, but the profession is losing its luster. Medical school graduates who don't get a residency end up working for insurance companies, universities, tech companies, or many other places where they never see an actual patient.
America's healthcare system has many problems that have been long debated- exorbitant costs, insurance companies denying claims, lacking coverage to rural areas, too much focus on quick fixes and expensive treatments, and not near enough focus on preventative care. Mental health and dental care are afterthoughts that barely enter into the discussion. Over half of the people who are forced to file bankruptcy do so because of medical debts. Everybody agrees it could be better, but the ones who have the power to change things are doing just fine, thank you.
I can remember when pre-existing conditions were a cause to lose healthcare coverage. At least the Affordable Care Act took care of that, and attempted to make things more affordable. But the system is too powerful and the players are too entrenched. Not much will change without a popular demand from enough people.
Meanwhile, the doctor shortage looms as the crisis no one seems to be talking about. The nursing shortage exists alongside for many of the same reasons. Many will instead choose to consult alternative intelligence, the internet, and a host of alternative medical options (some good, some bonkers) to step in when there's no doctor available. What are people to do who can't afford to or can't drive long distances to see a doctor? In our increasingly laissez faire system, the answer appears to be suck it up and die eventually.
My doctor, Dr. Brightfield, is a throwback to an older time in medicine. He was always calling to check up on me after a visit. I will miss him. We need millions more like him. But that won't happen unless someone figures out how to open up more residencies and attract more students into patient treatment.
I am still haunted by the visions of the dozens and dozens of sad, sick patients slumped in their chairs waiting to be seen in the emergency room. They didn't want to be there, they just wanted to feel better. I'm sure the doctors and nurses tried their best that night, but this is no way to run a health system. There has to be a better way and it starts at the very top- with the overworked doctors and nurses.
If you have a medical professional that you like, thank them for sticking with this insane system. If you don't, raise hell with whoever will listen. We deserve better than this shit. This is not acceptable now and it will most assuredly get worse the older and sicker we all get.