WHERE HAVE ALL THE DOCTORS GONE?
Incentives in our public and private health insurance are skewed away from prevention. The incentives for a medical graduate are to go into specialization. This incentive system has led to an excess of specialists and a paucity of preventive care primary care physicians. A recent survey of 1200 graduating medical school students indicated that only two percent were oriented to primary care. (TIME, 9/10/09). Because we have an excess of specialists, we don’t have the lines for elective surgery that exist in other countries. That is why a Canadian with means comes to the States for elective surgery. That is also why specialists, trained in Canada, come to the States to practice. To a great extent, that is why we spend over 16% of our GNP on medical care and most other countries spend (on average) 9%. That is also why our health statistics lump us with third world countries on such indicators as infant mortality. In addition, Dartmouth researcher, Elliott Fisher, M.D. suggests that too much health care may actually be killing us. His research indicates that as many as 30,000 Medicare recipients die annually from too much doctoring.
Primary care physicians report that up to sixty-five percent of what they are paid goes to administering their office. (Read Shannon Brownlee, July & August 2008 AARP Magazine, Why Does Health Care Cost So Much? Also read September 2008 AARP Bulletin.