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Print | Back Frequently
Asked Questions Part Four A. Granted,
there are thousands of extremely dedicated doctors and healthcare
workers. But this doesn't change the fact that there are millions
of people who do not receive adequate healthcare, and countless
diseases that cannot be diagnosed and treated. Q. I disagree with your suggestion that medical students would offer a valuable service to practicing physicians. Medical students (and junior-level residents) invariably slow-down experienced doctors due to their inefficiency. I am a full-time academic physician who enjoys teaching, but sees firsthand how well-meaning but inexperienced students and residents will decrease your ability to see patients efficiently. A. Many doctors pay good money to hire medical assistants. The function of the assistant in this proposal is to take patient histories, and record them in the chart. While he is doing this, the doctor is doing other things. The student is primarily learning from the patient, not the doctor. When the doctor sees the patient, he has the advantage of a detailed history that he would never have time to take himself. Keep in mind that this is voluntary. If the doctor doesn't wish to participate, he doesn't have to. Q. But aren't students already getting adequate patient interaction? Most medical schools begin patient/student interactions late in the first year or early in the second year. They are already spending time interacting with patients, although not several hours a day (until the third and fourth year). A. The student has had eight years of mostly irrelevant institutional learning before he even gets to medical school. Furthermore, the patient interaction in the first two years of medical school is usually very minimal. Q. Community physicians will need some type of compensation due to diminished ability to see patients efficiently under your model. A. Most of the teaching physicians in medical schools, internships, residencies and teaching clinics are volunteering their time free of charge. Furthermore, they are willing to commute a great distance do this. Doesn't it make more sense to have this take place in the doctor’s office, where no commuting is necessary, and a more intimate relationship can be established? Q. The most fundamental problem as I see it, is that
we have moved the rationing decision away from the user of the service,
to some third party. Years ago, each person had to make the rationing
decision, i.e. could they afford that care or not. Today, that decision
has basically been moved to some third party. The problem with
this new scheme, is there is no way to effectively hold down the cost
of medical inflation. Before the advent of our modern health
delivery system, medical cost inflation was lower than the overall
inflation rate. Since the move to this current system, the medical
inflation rate has consistently been above the overall inflation rate. As
a result, these third parties come up with all kinds of schemes to
hold down the rising cost of healthcare. An economist would say
this is rationing. But the problem is, this form of rationing
never works, because you have not changed the supply/demand dynamics
at work. All you have done is bought yourself some time. I
see only two ways out of this problem. One, is to return the
rationing decision to the consumer (not very likely), or some dramatic
productivity improvements that reduce the overall cost of providing
that care. |
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