Our Unequal United States: Where you Live Matters

The healthcare marketplace in the U.S. is undergoing rapid, wholesale change with no end in sight. The population continues to grow and, more importantly, age. At the same time the total amount of knowledge and capabilities that exist in the medical field is growing at an exponential rate as scientifically generated results from the laboratory are translated into new treatment protocols at an ever faster pace. The knowledge required to function as a Primary Care Physician today dwarfs that required of the previous generation of physicians.

Additionally, and regardless of the final details, the role of government will continue to grow. The scope of the government’s role will expand as implementation of the ACA (Affordable Care Act) is phased in over the next decade. Even if the ACA is repealed or significantly modified, the government’s percentage of involvement will grow as the population ages and end-of-life costs continue to be the majority of an individual’s medical lifetime cost.

Lastly, we are already facing staffing issues in the U.S. with vast discrepancies of accessibility to physicians based on where you live. According to the Association of American Medical Colleges, there were 744,224 licensed and active physicians in the U.S. in 2011. Of those, 208,802 were aged 60 or older. At the same time there were 80,279 enrolled in the 137 accredited U.S. medical schools. Assuming no attrition, medical school graduates transitioning into their clinical residency (3 to 7 years) will average 20,070 per year, fewer than those retiring. Thus, a diminishing pool of physicians will be serving a dramatically growing population as the uninsured population of the U.S. (40+ Million) is absorbed into the covered population under the ACA.

Change in this marketplace is unavoidable unless we find a way to suspend the economic theory (law?) of supply and demand. As my IT friends like to joke about their projects: pick any two – (high) quality, (low) cost, or timeliness. Which of us would accept poor quality, delayed access or increased costs regarding our personal access to healthcare?

To me, the plain but not simple answer involves seriously addressing the supply side of the equation. But creating more MDs more rapidly is viable only in the longer term and probably only after medical schools have drastically revamped their existing educational model.

Demand can be somewhat mitigated by the transfer of tasks from MDs to non MD clinicians, by increasing MD efficiency through the careful application of new technologies and by executing against the universally discussed focus on creating and maintaining health as opposed to focusing on the treatment of illness.

Each potential solution, or combination of solutions, presents its own challenges. And it may be that we must do them all to prevent either an access crisis or a fiscal crisis.

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