Question of the day
Thursday, Jul 25, 2019 - Posted by Rich Miller
* NYT…
Across the country, the escalating costs of medical school have driven young doctors away from lower-paying specialties, such as pediatrics and psychiatry, as well as jobs in rural or less wealthy areas.
The lack of primary care physicians is particularly acute in California, which has a growing aging population and the country’s largest Medicaid population — and one of the lowest state reimbursement rates for doctors in the country. California is projected to have a shortfall of 4,700 primary care clinicians by 2025, according to a 2017 report by the University of California, San Francisco.
The new program aims to change that using revenue from Proposition 56, which imposed a tax on tobacco products, to help physicians pay back their loans. It will disburse a total of $340 million. To qualify, the physicians, who receive up to $300,000 each in debt relief, must agree to spend a third of their time with Medi-Cal patients over the next five years. As part of the first round of funding, announced this month, 247 physicians will receive $58.6 million and 40 dentists will receive $10.5 million in debt relief.
Nearly 1,300 providers applied for the awards, according to the Department of Health Care Services. The program’s administrators said they assessed candidates based on personal statements, work history and specialization, among other factors. Applications for the next round of awards will be accepted in January.
Since the state was flooded with applications, maybe they should increase the mandatory five-year service period to ten.
Illinois also has an aging population, very low Medicaid reimbursement rates and shortages of physicians in certain specialties.
* The Question: Should Illinois institute a similar program? Take the poll and then explain your answer in comments, please…
panel management
- Econguy - Thursday, Jul 25, 19 @ 12:57 pm:
We need to train more doctors. Period. If it doesn’t increase the number of medical school slots, it’s simply a transfer to the existing pool of people coming through.
- Lt. Guv - Thursday, Jul 25, 19 @ 12:58 pm:
Both of the issues 1) lack of primary care doctors; and 2) Provider acceptance of Medicaid are real problems. Sounds as if this could be part of the solution for both.
- Candy Dogood - Thursday, Jul 25, 19 @ 1:01 pm:
The congressional district I live in only has about 10,000 house holds that make above $200,000 a year. The bulk of those are physicians.
I understand very well the financial constraints physicians are under and that rural areas are under served for primary care doctors and for specialists, however creating a transfer of many millions of dollars to individuals who are already established with hire earning potential than the bulk of our taxpayers is ridiculous on it’s face.
Using proceeds from tobacco sales to do it creates the unfortunate circumstances where taxes levied on lower income individuals (folks with highest rates of smoking) will be transferred to higher income individuals.
There are better ways to address this issue, and this isn’t going to encourage folks to pursue careers in medicine in rural areas.
Another delightfully complicating factor is that physicians are becoming a more diverse lot. There’s a lot of women and people of color coming up through the ranks and matriculating into and out of medical school.
Creating a financial incentive for a person of color to move to Southern Illinois or the “Eastern Bloc” may not be enough to overcome the attitudes that are leading to those areas to be represented by folks that are celebrating the confederate flag and the treason and racial oppression it represents.
There are better ways to address this problem, and if this is the route they go to do it, they should maybe explore using funds from taxing higher income individuals rather than tobacco use taxes.
- Blue Dog Dem - Thursday, Jul 25, 19 @ 1:04 pm:
As these young doctors go about their residency program, they barely make minimum wage. Make the hospitals pay real wages as well.
- OneMan - Thursday, Jul 25, 19 @ 1:08 pm:
Might be able to increase the scope of practice of NPs and PAs and address some of these issues as well at a lower cost.
- Candy Dogood - Thursday, Jul 25, 19 @ 1:09 pm:
===As these young doctors go about their residency program, they barely make minimum wage. Make the hospitals pay real wages as well.===
While I agree that wages during residency and fellowship should be higher, this won’t address the shortage of physicians in undeserved areas.
It’s very uncommon for a residency program to fail to fill all of it’s residency spots one way or another and resident physicians are forced to accept poor working conditions because a residency is required to become a fully licensed physician.
Hence residency programs in under served areas will typically have all of their residency spots filled, but physicians may not stay in those areas. For example, the most competitive recent medical school graduates choose a residency program in Long Beach Florida over say, North Platte, Nebraska. The person that winds up going to the North Platte Nebraska residency program probably has few ties to the area and little incentive to stay there after completing their training.
Even if the pay is great and the cost of living is low.
This is especially true if the physician is married to a person with a graduate degree in a non-medical field.
- JS Mill - Thursday, Jul 25, 19 @ 1:09 pm:
Psychiatric care is in particularly dire need outside of metro Chicago.
McLean county did not have a psychiatrist that was taking adolescent patients for a period of time. They are very important when it comes to meds for patients.
- A Jack - Thursday, Jul 25, 19 @ 1:10 pm:
I voted no. One big problem that Illinois has in attracting doctors is the high cost of medical malpractice insurance. The GA should look at that issue first. Also perhaps Illinois should pay down some debt before creating another program.
- TheInvisibleMan - Thursday, Jul 25, 19 @ 1:11 pm:
After reading that “DuQuoin Boycott FB Page”, there is no amount of mental health funding for rural areas that would be too much.
- Candy Dogood - Thursday, Jul 25, 19 @ 1:14 pm:
===Might be able to increase the scope of practice of NPs and PAs===
I realize I just wrote a post that suggests that racists may not deserve good access to physicians, but there is a significant difference between the training of a NP and a PA and should not be considered equivalent to a physician.
I understand we live in an era where Physicians Assistants want to be called “PAs” instead, but if we’re going to increase reliable access to healthcare in rural areas we should do that without cheapening the quality of healthcare.
- Norseman - Thursday, Jul 25, 19 @ 1:14 pm:
I said yes, because there are already programs on the books. One plugs in national funding. I see by IDPH’s site that related IL funded programs are not giving grants at this time. I haven’t verified, but I suspect that they were cut in a austerity move.
http://www.dph.illinois.gov/topics-services/life-stages-populations/rural-underserved-populations/slrp
- Candy Dogood - Thursday, Jul 25, 19 @ 1:16 pm:
=== there is no amount of mental health funding for rural areas that would be too much===
They still won’t appreciate the state investing heavily in their communities and will still believe that their tax dollars fund Chicago.
- Anon221 - Thursday, Jul 25, 19 @ 1:18 pm:
Yes. But not through a tax. Look toward how the opiod settlement dollars. And… make sure the doctors in training are receiving training on how to take time with their patients instead of relying on the prescription pad.
- Anon221 - Thursday, Jul 25, 19 @ 1:19 pm:
Correction- Look toward how the opiod settlement dollars might be used.
- Captain Obvious - Thursday, Jul 25, 19 @ 1:21 pm:
Paid for how? An even higher cigarette tax? Already near or past the point of diminishing returns there. Might have to raise income taxes on the poor folks under 250k after all to do it. Or tax services, or retirement income, or the air we breathe.
- Last Bull Moose - Thursday, Jul 25, 19 @ 1:27 pm:
The United States is producing too few physicians. And because of the cost, the profession attracts people with a high desire for money. They may have a lower desire to serve.
Currently 25% of our physicians are born overseas. That is a measure of how much we fall short.
Yes Nurse Practitioners will help. There too we are making the time and cost excessively high.
- Rasselas - Thursday, Jul 25, 19 @ 1:40 pm:
The comments are mostly negative, but the vote is lopsidedly yes. Something going on here?
I voted no. Agree with all the above - we need more doctors created (current artificially low number is creating artificially high salaries, leading to shortage in less attractive areas), we need expanded scope of care of PAs and RNs. This is just an income transfer to an already privileged group in society
- Flapdoodle - Thursday, Jul 25, 19 @ 1:52 pm:
I’m an oldster living in a rural mid-state county, in a small city with a regional health care facility. For a while here there were no primary care physicians accepting new patients. Local access to specialized care, particularly mental health, is quite limited. This is all without reference to practices accepting Medicaid, which makes the problem worse. Something needs to be done to ensure care where its needed. If it takes programs modeled after — gasp — California, then so be it. Because the pursuit of happiness is damnably difficult when suffering from poor health.
- wonkavist - Thursday, Jul 25, 19 @ 1:57 pm:
Voted No because in the bigger picture this will only contribute to the continued rise in medical costs (including the cost of medical school). We need larger scale more holistic solutions.
- Techie - Thursday, Jul 25, 19 @ 1:57 pm:
I’m generally in favor of free college tuition; not only is a college education of post-high school vocational training practically necessary for a decent job, but it’s what most of the rest of the developed world already does. We live in a global economy, so why would we put ourselves at a competitive disadvantage by not making sure we have one of the best-educated workforces in the world?
Moreover, if anybody should be getting assistance with education for their career, it’s people who literally save lives - doctors, nurses, etc. So I’m all onboard with setting up a program where doctors who spend time with low-income patients get student debt relief.
- Morninstar - Thursday, Jul 25, 19 @ 1:59 pm:
Recruiting providers to underserved areas of the state is challenging. Not everyone wants to live in rural communities. But if I am not mistaken, Illinois already has a similar program - the National Health Service Corps/Illinois State Loan Repayment Program. It could use additional funding so that more eligible applicants could be encouraged to work in underserved communities.
- Weirdo - Thursday, Jul 25, 19 @ 2:01 pm:
Having 300k in loans while being taxed at the highest rates doesn’t make it easy. Doctors do fine, but should be rewarded for the amount of effort they put in with constant 24 hour shifts. They definitely aren’t rewarded in the first ten years as they have to pay the student loans off.
- Dotnonymous - Thursday, Jul 25, 19 @ 2:03 pm:
I voted yes…because Eastern Bloc.
- NoGifts - Thursday, Jul 25, 19 @ 2:07 pm:
No because the program as described doesn’t address the geographic distribution of doctors.
- phenom_Anon - Thursday, Jul 25, 19 @ 2:15 pm:
I voted yes, but with the idea that it wouldn’t have to be exactly like the California program. I think in Illinois it would definitely need a geographic component as well.
- Dupage Bard - Thursday, Jul 25, 19 @ 2:16 pm:
I voted no- removing debt isn’t going to make docs go to rural areas nor will it increase the docs going in to lower paying specialties. Plus which pot of money will this come from?
Also when you start talking rural areas losing docs aren’t these the same folks who don’t want to be part of Chicago? Maybe they can get docs to move down there for their farm subsidies and some eggs and chickens?
- City Zen - Thursday, Jul 25, 19 @ 2:17 pm:
Lots of great comments here. Not sure how you’re going to attract more doctors to rural communities unless you’re already drawn to that lifestyle. Nothing against Taylorville, but that’s a lot of studying and schooling to endure to end up in, well, Taylorville.
==Since the state was flooded with applications, maybe they should increase the mandatory five-year service period to ten.==
My local fire district, among many others, has a waiting list a mile long. Should we decrease benefits there as well for applicants?
- Benjamin - Thursday, Jul 25, 19 @ 2:17 pm:
I voted no. The problem is the shortage of doctors, and that’s caused by the shortage of slots in medical schools. There’s no shortage of eager young pre-med students who could hack it in a med school program–I bet you could fill another teaching hospital with the kids who didn’t do quite well enough on the MCAT last year.
If we want to devote millions to keeping doctors in our small towns and rural areas, let’s build a new medical school, or expand the ones we have, and help alleviate the shortage. (A new med school would be a great boon to some of our struggling state universities, by the way, though that shouldn’t be the main reason to build one.)
- {Sigh} - Thursday, Jul 25, 19 @ 2:18 pm:
Shortage of physicians in rural areas is not the only problem. In the Eastern Bloc there is a community that has no paramedics. So if you call 911 and need help the ambulance cannot provide any medical assistance. The ambulance can only transport. Maybe Rep. Miller could focus on addressing real issues in his district.
- West Town TB - Thursday, Jul 25, 19 @ 2:26 pm:
I voted yes- the shortage of doctors is becoming more and more of a problem and is a major driver of medical costs, not to mention the impact on distribution and quality of care.
This only deals with part of the problem though- how to better distribute doctors geographically and by specialty. The real issue is the limitation of openings to get into a residency program, which is controlled by Congress (after lobby from the AMA). https://thehill.com/blogs/congress-blog/healthcare/266610-shortage-of-residency-slots-may-have-chilling-effect-on-next
- OneMan - Thursday, Jul 25, 19 @ 2:31 pm:
Candy Dogood,
Going to admit I have a bias since my wife is an NP
No one is saying that an NP should be doing your brain surgery, but you don’t need to have spent years in a residency to figure out if someone has strep or to deal with a sprain.
If people were not happy seing advanced pracitioners in clinical settings, you wouldn’t see the minute-clinic model all over the place in suburban areas. People like the convenience of the care, the quality of the care and the cost of the care.
Even if you are able to provide incentives to get more GPs in rural areas, it is going to make business sense for them to have APNs or NPs on their staffs.
Research in 2014 found
https://www.ncbi.nlm.nih.gov/books/NBK384613/
They are already doing primarily primary care 87% vs 14.5% of physicians.
Same level of outcomes in diabetic treatment
https://www.medscape.com/viewarticle/905366
or some more general information
https://c.ymcdn.com/sites/www.pacnp.org/resource/resmgr/imported/qualityofpractice.pdf
- Cheryl44 - Thursday, Jul 25, 19 @ 2:51 pm:
I had a friend in college who grew up in a small town because his MD father was recruited via a program similar to this. So yeah, it can work.
Other things to look into are NPs and PAs doing a lot of stuff that you really don’t need an MD doing. Also, telemedicine.
- Amalia - Thursday, Jul 25, 19 @ 2:54 pm:
Yes. we need every day type of docs. but it’s more complicated than about salary money. Psychiatry is less desirable because of the danger of it and the lawsuits. Same might be true of pediatrics, the lawsuits. this is certainly true for obstetrics. what is true is that money is driving the smartest doctors to one specialty….dermatology. The smartest residents want that specialty because they can get into the Botox angle. sad. and it’s kinda easier. the least desired residency is psychiatry. Money should also get behind finding actual relationships between psychiatric issues and chemical imbalances. For example, at Northwestern they are doing research on depression and teens and found a blood marker to help indicate which drugs will be most useful in helping the issue. More of this research needs to be done. and then I predict psychiatry would be more lucrative because patients would have a closer and more predictable relationship between medicine and mind.
- Earnest - Thursday, Jul 25, 19 @ 2:55 pm:
I voted ‘no.’ I don’t oppose investments or other approaches to target specific specialty or geographic needs.
- Dave W - Thursday, Jul 25, 19 @ 3:00 pm:
No, this state is broke and we can’t afford more new programs.
College tuition is unaffordable for one primary reason: many years ago, the federal government created a massive expansion in the amount of available credit in the federal student loan program. This allowed colleges and university to raise tuition by more than 5 times the rate of inflation, year over year, because they know that students will foolishly borrow whatever it takes to attend the school.
The solution: the federal government should announce that they’re reducing the credit available by 10% year year for the next 5 years. You will see tuition prices plummet overnight.
- illinifan - Thursday, Jul 25, 19 @ 3:01 pm:
Yes especially for primary care physicians who generally have long hours and is one of the lower wage practices. I also agree that other specialities should be considered based on geographic shortages such as neurosurgeons and psychiatrists in southern Illinois. I also agree with some posters who recommend addressing the malpractice issue.
- DarkDante - Thursday, Jul 25, 19 @ 3:34 pm:
Voted yes. There is a certain alignment of utilizing tobacco excise tax revenue to provide better medical care. I think most the new incremental revenue related to tobacco taxation is tailored to the capital bill (not much logical alignment between the form of taxation and the usage of the revenue here btw), but this is something to consider in the future, as those revenue sources are freed up.
- LRH - Thursday, Jul 25, 19 @ 3:55 pm:
Voted no because psychiatry is nothing but a scam and a contributing factor in the opoid crisis going on right now. OT
- TinyDancer(FKASue) - Thursday, Jul 25, 19 @ 4:06 pm:
No. This is a bandaid solution.
The private sector isn’t doing such a good job at healthcare. We need to take a sledgehammer to it.
Get rid of the predatory profit motive:
Get rid of Big Pharma (most research is taxpayer-funded NIH anyway.)
Get rid of the insurance companies and middlemen.
The savings will pay for universal healthcare and free/cheap med school tuition.
- Nameless - Thursday, Jul 25, 19 @ 4:21 pm:
I voted Yes, but with this caveat, Doctors must work independently, not part of some super-conglomerate health care provider, i.e. HSHS, Memorial Health Care, etc.
- Bev - Thursday, Jul 25, 19 @ 4:58 pm:
The shortage of dentists in rural areas could be solved by dental therapists.
- Candy Dogood - Thursday, Jul 25, 19 @ 5:11 pm:
===you don’t need to have spent years in a residency to figure out if someone has strep or to deal with a sprain.===
I agree, but you’re cherry picking your medical conditions to one that literally requires verification via lap result, and one that will also involve an eventual ex-ray to rule out a fracture.
I’m not advocating against nurse practitioners or PAs being involved in patient care, I’m suggesting that the solution to a physician shortage shouldn’t be to make it easier for folks to be seen by a not a physician.
There are PAs out there advocating for broad expansions of their ability to practice without supervision, and if your spouse is a nurse practitioner I am certain she recognizes that a PA isn’t as good as her training either.
===87% vs 14.5%===
Your data seems to suggest that there are fewer options for practice for nurse practitioners than physicians.
- Ares - Thursday, Jul 25, 19 @ 11:08 pm:
- Increase IL medical school enrollments
- reduce medical school tuition at IL state schools to 0
- Reduce dependence on non-US citizen medical school graduates
- Illini fan - Friday, Jul 26, 19 @ 7:33 am:
I would assume most of the docs are existing docs who wouldn’t leave the state anyway
We do not need new taxes or new programs.
- WH Mess - Friday, Jul 26, 19 @ 8:31 am:
We desperately need more psychiatrists. For acute needs, families choose between a six-month wait for an appointment or going to the emergency room.