The U.S. has a critical shortage of health care professionals: nurses, mental health therapists, and particularly physicians. The shortage has been worsening over the years and is now at crisis levels, with wait times for care so long that people are dying waiting for care.
It was recently suggested that Congress fix the problem of doctor shortage by facilitating the in-migration of trained physicians from other countries. After all, Washington has more than six decades’ experience in fixing health care with an impressive track record!
To solve a problem, one must first identify the cause of the problem. There are several reasons for the U.S. doctor shortage.
The first and most obvious is the overwhelming, time-devouring regulatory and administrative burden placed on physicians by federal health care bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement — or BARRCOME.
Any time Congress fixes a problem, it does so by creating BARRCOME, which costs money. Approximately half (!) of all U.S. “health care” spending goes to BARRCOME, not care. Since the U.S. spent $4.3 trillion on its health care system in 2022, roughly $2 trillion “care” dollars were diverted from patients’ needs to pay for health care bureaucrats, both government and insurance. Expressed more bluntly, Washington stole $2 trillion worth of Americans’ medical care to pay its non-clinical minions.
For example, to pay for BARRCOME in the Affordable Care Act, $716 billion was taken from the Medicare Trust, money intended to pay for seniors’ hospital care.
Asking Congress to pass legislation, adding more BARRCOME, to entice outside physicians to migrate here will a) cost millions, possibly billions, b) take even more money away from patient care, c) make enemies of our allies, who have their own critical doctor shortages; and d) won’t work. The reasons why physicians are leaving Great Britain’s NHS are the same reasons why American physicians are quitting our system. Why would British MDs jump out of a British frying pan into an American fire?
Another important reason for the doctor shortage is psychological.
Physicians endure all those years of school and training along with long hours and great emotional as well as physical stress for one reason above others: to obtain a psychic reward. Maslow described it as the highest of human needs, self-actualization, discovering the meaning for that person’s life and achieving it. As one nurse described the psychic reward, “When my babies [her patients] do well, it feeds my soul.”
The current U.S. health care system with its third-party decision making disconnects physicians from their patients emotionally (as well as financially) — no psychic reward. The depersonalization that patients rightly resent is felt equally by care providers. My former physician had an assigned list of more than 900 patients. Surgeons often first learn the patient’s name from that day’s operating schedule.
Physicians cannot use their own best judgment on a patient — they must comply with federal clinical guidelines, FDA and CDC advisories and prohibitions, pharmacy benefits managers’ limited allowable drug list, and insurance companies dictating where, when, and by whom procedures are done. Doctors have all the responsibility but are denied the necessary authority. They work in a system where federal government believes it must protect the patient from the doctor! (READ MORE: America’s Drug Supply Depends on India and China. You Should Fix That, FDA.)
Anyone who questions the above should consider how Washington took away all COVID decision making from clinicians and gave it to one-size-fits-all federal bureaucrat MDs, who, like Anthony Fauci, practice paper-pushing, not medicine. This was an extreme form of devaluation.
Devaluation of physicians is not only psychological but financial. Doctors’ charges — how they value their work — are summarily ignored, as insurance pays whatever it chooses, a small, fixed amount based on Washington’s allowable reimbursement schedules. This author’s charges for a cauterization procedure in a critically ill cardiac newborn ranged from $2,500 to as much as $9,000 if medical devices were necessary. Medicaid’s maximum allowable payment for my work was $387.
Between Washington’s third-party-enforced devaluation and disconnection, physicians get neither psychic reward nor fair compensation for their work. The result is the doctor shortage.
Asking federal politicians to fix the doctor shortage is like asking an arsonist to put out the fire he started.
To prevent the arsonist from doing more damage, take him out of circulation. To stop Washington from driving more doctors out of practicing medicine, remove federal third-party control of health care and return financial decision making — along with medical freedom, or autonomy, the right to choose — where they belong, in the hands of We the Patients.
Deane Waldman, M.D., MBA, is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.