What Really Causes Physician Shortages?
Monday, May 7th, 2012
The last post debunked the fairy tale that malpractice reform is a sure cure for doctor shortages. Lets look for a minute at where doctor shortages exist in the U.S. and what’s really causing them.
Wall Street Wire looked at data from the American Medical Association, the U.S. Census Bureau, the Kaiser Family Foundation, and other sources to determine which states had the biggest doctor shortage problem. A look at this chart shows no correlation between shortages and “tort reform,” one way or another.
Several of the states in the “top” ten list of states with the biggest shortages — notably Georgia (#2), Mississippi (#4), and Texas (#6) have “malpractice reform” laws in place that were supposed to solve the shortage problem, but clearly haven’t.
Just three years ago Arizona Senator John Kyl was sending out press releases crowing about how Arizona’s malpractice reform laws were solving that state’s physician shortage, and complaining that the “president and congressional Democrats have not asked anything of personal-injury trial lawyers.”
According to Wall Street Wire, Arizona today has the worst physician shortage problem in the nation. It’s Number One! Or, it’s Number 50!, depending on whether you are counting “worsts” or “bests.”
In state after state, lobbyists from the insurance industry and other special interest groups are telling legislators that malpractice reform, often within a bigger “tort reform” package, is the silver bullet that will solve their physician shortages. And you can find politicians and industry spokespeople claiming many spectacular results. But when you look at actual numbers, the results just aren’t there.
The same thing goes for claims that “tort reform” will attract industry to a state and grow jobs. This is something one hears over and over again, yet the supporting evidence is remarkably weak. The fact is that legislators are trading away your right to sue for damages in return for promises that don’t come true. And the people who suffer most are the ones with the most damage, such as those suffering mesothelioma cancer from exposure to asbestos.
So malpractice reform doesn’t make that much difference in how many doctors are practicing medicine in any one state. What are states really doing wrong, or right, to be sure there are enough doctors to take care of its citizens?
When people talk about physician shortages, they are usually looking at the ratio of doctors to patients. The standard measure is the number of doctors per one thousand people living in a particular area. Sometimes a state has rapid population growth that will skew its doctor-to-patient ratio for a while. That may be part of Arizona’s problem.
A more important factor probably is the number of physician internships and residencies in a state. As you probably know, after medical school aspiring doctors work as interns and residents under the supervision of licensed physicians. Many doctors begin practice near where they went through their medical residencies.
These residencies usually are partly funded by state taxes, and as states have cut their budgets they have trimmed residencies. This appears to be one reason why Texas is continuing to struggle with physician shortages. Texas is home to many first-rate medical schools, but increasing numbers of medical school grads find they must go to another state for their residencies. And usually they don’t come back, in spite of Texas having reformed its malpractice laws every which way it can.
One aspect of physician shortages is that populations need more general practice doctors than they need, say, plastic surgeons. But most medical school graduates go out into the world burdened by whopping student loan debts. This inspires a disproportionate number of them to go into specialties that will give them higher incomes than GPs can make.
In short, there are many reasons why some parts of the country have more doctors than other parts. Compared to those other factors, a state’s malpractice laws make a very minor impact.
