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Assorted links
1. My radio dialogue with Eliot Spitzer on financial regulation.
2. Using brain scans to increase social cooperation.
3. Gratitude enhances cooperation.
4. The supply and demand for doctors.
5. Someone thinks we should put lithium in the water supply.
Posted by Tyler Cowen on September 11, 2009 at 11:40 AM in Web/Tech | Permalink
Comments
I was favorably surprised by Spitzer in the first link.
Posted by: Brian Moore at Sep 11, 2009 11:47:02 AM
Sorry for the two posts, but this line at the end of link 4 is extremely important:
"Health care reform is absolutely on a collision course with the doctor shortage. Something has to be done about it, and it is spelled GME." (Graduate Medical Education)
Anyone's plans for healthcare reform are pretty irrelevant in the face of not having enough doctors to execute them.
"Women physicians these days are increasingly dropping out of practice altogether in their 40s or early 50s. And men are seeking better lifestyle arrangements, too."
This is because the medical profession is not very forgiving to part-time employment (there are high fixed operating costs). You can't phase out slowly like you might be able to with other jobs -- and being a physician in your 50's means you have been working very hard for at least 28 solid years. The "lifestyle" issue is very big for both men and women.
As we value leisure and lifestyle more and more, becoming a doctor is becoming less and less appealing. Not everyone is willing to accept major curtailment of friends, family, hobbies, relaxation, sleep, dating and kids during the best years of their life -- and make no mistake, that is what you accept if you are going to medical school and residency. Especially during internal medicine residencies (the one all those "primary care physicians" we want to have will be enduring) you are looking at 70-100 hour work weeks (yes, it's "capped" at 80 hours officially, but that's like saying drugs are illegal, so no one will have them). At the upper end of the most competitive residency programs, working 100 hours a week doesn't mean just losing the things above, it means losing things like sitting down, eating, any sleep at all, and going to bathroom when you need to. If you want some scary statistics, look up how many residents abuse alcohol, prescription drugs, are on anti-depressants, are in therapy, etc...
The only reason we're not facing an even more massive shortage right now is that residency programs are highly incentivized (up to including yearly 6 digit bribes from medicaid/care per resident) to retain residents they've conned into coming to their programs, and so have erected very high barriers to exit, or even changing specialties. Plus there are natural barriers, such as the sunk cost fallacy that "all those years would be wasted if I left" and your student loans, which can range up to a quarter of a million or more.
Posted by: Brian Moore at Sep 11, 2009 12:12:38 PM
From link #5: I believe it is fair to say that this writing energized a field in philosophy that centers on the word “enhancement,” a term that encompasses a set of medical interventions in which the goal is not to cure illness but rather to alter normal traits and abilities..
Statements like this illustrate how doctors are behind the curve and tend to aggrandize themselves. Doctors get to label someone as "diseased" or "ill" and then its fine to throw drugs at such people. But mental health, like most things, is better viewed as a continuum than as a binary variable. If you are with it enough to see this, then all forms of mental health medication are "enhancements".
Posted by: Curt Fischer at Sep 11, 2009 12:23:36 PM
"Someone thinks we should put lithium in the water supply."
Who's to say we aren't already?
http://www.straightdope.com/columns/read/2723/people-take-medications-they-excrete-them-what-happens-next
Posted by: Thelonious_Nick at Sep 11, 2009 12:23:46 PM
Supply of doctors matters?! Government works with docotrs unions(AMA) to structure licensing of who can do various health care procedures...and this increases costs?! what?...it couldn't be...
No, I think we will just cut costs by forcing more people to buy more insurance. The costs of the various government programs are surely being over-estimated, because we will save a lot of money when health care costs are lowered.
Posted by: Gabe at Sep 11, 2009 12:27:44 PM
aren't most mental illness drugs terrible anyway? i'd be more concerned about it being a waste than it will help or hurt anyone.
Posted by: anony at Sep 11, 2009 12:33:24 PM
That interview about doctors was pretty worthless. Also, since when did people believe that there was a surplus of doctors? It is a high-paying profession with lots of barriers to entry...oh no, that doesn't sound like the characteristics of something with a shortage at all!
Posted by: derek at Sep 11, 2009 12:47:16 PM
"So I did a simple calculation to determine what the population was likely to be in 15 or 20 years. For the COGME model to work, the population had to stay constant. That didn’t make sense, so I called the Census Bureau. They said, oh no, we thought that the before the 1990 Census but we don’t think that way anymore. So they sent me their projections in an envelope – not an email – email hadn’t been invented. I took their numbers and plugged them COGME’s physician supply projections, and sure enough, there was not going to be a surplus of about, but a shortage."
now, 20 years later, is there a shortage?
Posted by: dkahn at Sep 11, 2009 1:24:25 PM
Did Spitzer call for more regulations on the price of hookers?
Posted by: Peter at Sep 11, 2009 1:53:00 PM
Take-away transcript says COWAN- I'd ask for a correction.
Posted by: jsol at Sep 11, 2009 3:11:38 PM
The US has 2.4 practicing physicians per 1,000 population (2004 numbers).
This is less than some countries (France & Germany: 3.4) but more than others (UK: 2.3, Canada: 2.1, Japan: 2.0). So I don't see the "doctor shortage".
Now our doctors do make more (US GPs make $161K, compared with UK: $118K, Canada: $107K, France: $92K, in PPP 2004). I suspect this is because countries with more socialized health systems apply greater cost control to doctors.
Source: http://wikileaks.org/wiki/CRS-RL34175
Congressional Research Service Report RL34175 "The U.S. Health Care Spending: Comparison with Other OECD Countries"
Posted by: Mr. Econotrian at Sep 11, 2009 3:51:23 PM
The real story in link #5 is the comment by Alyson D, an apparent spam bot for personalmoneyloans dot com. Look at the text of the comment, it is almost indecipherable from an actual comment. It accurately summarizes the article, and seems to make an intelligible comment (in the comment the words "money loans" are hyperlinked to the aforementioned loan site). I wonder if this was done by a bot or an actual human in India, perhaps? Are there bots capable of making a spam comment that sophisticated? Amazing the lengths the spammers go to these days...
"I have also read in the web that according to a new study, very low levels of lithium in drinking water may help prevent suicide in the general population. Lithium is a naturally occurring metal found in variable amounts in food and water. In medicine, very high doses are used to treat bipolar disorder and mood disorders. But so far the potential benefit of using low levels of lithium to reduce the risk of suicide has not been studied closely and may need money loansfor continued research."
Posted by: Doug at Sep 11, 2009 6:03:46 PM
Did Spitzer call for more regulations on the price of hookers?
Peter,
Did he say he wants the Fed or the Treasury to do this?
Or maybe the DOJ?
Posted by: AADL at Sep 11, 2009 6:39:21 PM
"What I discovered was a lot of smart people trying to figure out how the health system works from data alone. But you have to live it. You can’t figure out why a baseball team wins or loses from statistics. You have to understand the mind of a baseball player and the dynamics of the game. The same is true a hundred-fold over in health care."
Don't the Athletics have something to say about this? (Or even the Red Sox?)
Posted by: Student at Sep 11, 2009 9:00:19 PM
#5 quote:
"Wealth is a source of health care creation; poverty is a source of health care consumption."
Posted by: anon at Sep 11, 2009 9:34:00 PM
And yet a shortage of doctors is being met by falling pay, as Medicare reimbursements get slashed year after year. Sounds like a government-induced market failure to me.
Posted by: athelas at Sep 11, 2009 11:25:59 PM
Doug, prepare to be disappointed: the spambot comment seems to be a couple of sentences copied directly from this article:
http://www.telegraph.co.uk/health/healthnews/5251365/Natural-levels-of-lithium-in-drinking-water-help-reduce-suicides.html
I bet a human typed up the message, and has a bot spamming it in every "lithium" related comments section, figuring they'd mostly be (or at least include) recaps of the original article.
Posted by: MikeF at Sep 11, 2009 11:41:17 PM
Turns out that, at least in New York State, if a doctor sees you twice, he is obligated to treat you for the rest of your life. He can attempt to release you from his care, but if you cannot find another physician who will accept you, he cannot not treat you.
Can everyone see how this would lead to a doctor's reluctance to "accept new patients"? And a consequent shortage of doctors, or at least doctors willing to accept new patients?
Obviously this is the result of some well-intentioned legislation designed to ensure that people would have access to medical care. Like most attempts to hamper the marketplace, it accomplishes the *opposite* of its goal over the long term. FAIL.
Posted by: Russell Nelson at Sep 12, 2009 2:20:49 AM
The article was not about a shortage of doctors. It is about massaging data to fit your agenda.
Posted by: Andrew at Sep 12, 2009 11:46:29 AM
Yes, all cities should spike the water supply with lithium salts! It would certainly cause less damage than fluorine salts!
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Posted by: souris at Sep 14, 2009 3:14:54 AM
