Physician Shortage: An Alternative View by the Numbers | Robert Nelson, MD | LinkedIn

LW439-MC-Escher-Waterfall-19611For the sake of brevity, I am not going to show my math.  Trust me, I’m a doctor!  Here are the average panel sizes based on the assumptions above using 2012 census data.

  • FP/GP = 1,041 patients per doc
  • IM/IM-Peds = 464 patients per doc
  • Pediatrics = 552 patients per doc
  • Ob-Gyn = 642 patients per doc
  • Geriatrics = 1,237 patients per doc (this was tough to estimate, maybe way off)

Take a close look at the patient panel sizes.  Yes, they are derived from raw data and don’t represent actual practices, but they do represent every single individual via census data that were represented in the categories that I used.  Why are they so much lower than the “average” U.S. primary care doctor patient panel numbers we see quoted so often?  The panel sizes would be larger if we count those with more than one doctor, but that would be a wild guess.  But, that effect is dwarfed by the fact that I assumed every single American in the age/gender categories that I used has a personal physician, which we know is not the case. There is the issue of uneven distribution of doctors, with more in urban/suburban area compared to rural areas, tending to skew sampling surveys to higher panel sizes.  The other sampling bias of surveys may be web presence of the practice.  Again, these practices are easier to locate and contact; which might also account for why they have larger patient populations.

So it the physician shortage real?  I don’t know.  I do know access to supply is out of balance and we can do much better with some efficiency enhancers.

Source: Physician Shortage: An Alternative View by the Numbers | Robert Nelson, MD | LinkedIn

Nobody Is Pushing Thomas Piketty’s Policies to Combat Economic Inequality – Michael Barone – Page full

blog_piketty_r_vs_g_highlightA recent Congressional Budget Office report shows that when you measure federal taxes paid minus federal transfers received welfare, food stamps, Social Security, etc., the top 20 percent of earners pay an average of $46,500. The next 20 percent pay an average of $700. The bottom three-fifths get back more than they pay. Plus, the U.S. already relies more heavily on the income tax for revenues than any other advanced economy nation.

In other words, America already has lots of economic redistribution. American voters evidently sense that more redistribution would sap economic growth. They’re willing to throw a little to minimum wage earners, but they don’t want to kill the geese laying the golden eggs.

Americans are not alone in feeling that way. You don’t see much demand for Piketty policies in other countries either.

via Nobody Is Pushing Thomas Piketty’s Policies to Combat Economic Inequality – Michael Barone – Page full.

Is Medicaid-Associated Overuse of Emergency Departments Just a Temporary Surge? | Health Policy Blog | NCPA.org

Rates of Emergency Room Visits per Quarter

What is important to remember about Medicaid and similar programs is that you can sign up when you need care. People with private insurance can only sign up during open-enrollment periods.

Sure, the people who sign up for Medicaid will consume a lot of medical care and then drop off. But they will also drop out of Medicaid until they need it again. Meanwhile, eligible people who become sick will sign up next month. It never stops.

And it certainly does not address the problem that Medicaid provides poor access to physicians. If it did, the newly covered would not have had to flood hospitals’ emergency departments.

Is Medicaid-Associated Overuse of Emergency Departments Just a Temporary Surge? | Health Policy Blog | NCPA.org.

Medicine’s Top Earners Are Not the M.D.s – NYTimes.com

THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.

That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

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And studies suggest that administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. American insurers, meanwhile, spent $606 per person on administrative costs, more than twice as much as in any other developed country and more than three times as much as many, according to a study by the Commonwealth Fund.

As a result of the system’s complexity, there are many jobs descriptions for positions that often don’t exist elsewhere: medical coders, claims adjusters, medical device brokers, drug purchasers — not to mention the “navigators” created by the Affordable Care Act.

Among doctors, there is growing frustration over the army of businesspeople around them and the impact of administrative costs, which are reflected in inflated charges for medical services.

via Medicine’s Top Earners Are Not the M.D.s – NYTimes.com.

A Tiger of a Book – Thomas Sowell – Page full

Those in the media, in politics and in academia who seem determined to blame American society for individuals and groups who do not rise would be hard-pressed to explain why immigrants of various colors come in at the bottom and proceed to rise, both in the schools and in the economy — on both sides of the Atlantic.

It would probably never occur to those who are eager to blame “society” that it is they and their welfare state ideology who have, for generations, burdened the underclass with a vision of hopeless victimhood that immigrants have been spared.

By the time various immigrant groups have been here for generations, they have already risen, despite the welfare state ideology that says that they cannot rise.

That so many in the media and in academia who proclaim the end of social mobility in America leave out the fact that data they cite do not include various immigrant groups tells you all you need to know about them.

“The Triple Package” is a book that tells us much that we all need to know about America — especially if we want to keep the welfare state ideology from destroying the American Dream.

via A Tiger of a Book – Thomas Sowell – Page full.

The Affordable Coffee Act » Eric Peters Autos

free Starbucks picture

I mean, why not?

If government – using its magical powers – can make health care “affordable” why not make everything people need (and hell, everything they want) affordable?

It’s a little mean-spirited to lower the cost of going to the doctor, but do nothing to make a Starbucks latte – or a new Corvette – cost less, if government has the power.

Everyone a millionaire! A turkey in every pot! Six pack abs for all!

Maybe everyone has a right to a best friend and a good head of hair, too.

You’d have to be what they call in Vegas a mark to believe it.

And yet, people do believe it.

via The Affordable Coffee Act » Eric Peters Autos.

Monetarism, Abenomics, QE, and Minimum Wage Proposals: One Bad Idea Leads to Another, and Another – Mike Shedlock

via Monetarism, Abenomics, QE, and Minimum Wage Proposals: One Bad Idea Leads to Another, and Another – Mike Shedlock.

Brief History: 

Monetarists act on the theory falling prices are a bad idea

The Fed prints money and holds rates too low

Housing bubble builds

Medical and education prices soar

Student loans soar to “help” the students

Because housing is not affordable numerous affordable housing programs appear causing still more unwarranted housing demand. Few see the bubble because housing is not in the CPI

Housing crashes

The affordable housing advocates are abhorred by falling prices

Fed bails out banks and steps in to support housing prices

Income inequality soars

Students remain stuck with debt

Because of one idiotic notion, that “falling prices are a bad thing”, the Fed has generally managed to keep the CPI rising, with some things going up much faster than others.

In response to uneven price inflation, we have seen numerous “affordable housing” programs, massive student aid programs, bank bailouts at taxpayer expense, Obamacare to make medical insurance affordable, cash for clunkers, Abenomics in Japan, and countless other economic idiocies.

People propose bad idea after bad idea simply to fix problems caused by the previous bad idea. This is corollary six to the Law of Bad Ideas.

Law of Bad Ideas Corollary Six: Bad ideas lead to more bad ideas to fix problems caused by previous bad ideas.

The ‘Fairness’ Fraud – Thomas Sowell – Page full

Thomas SowellAt least one of the recent celebrated statistical studies of social mobility leaves out Asian Americans. Immigrants from Asia are among a number of groups, including American-born Mormons, whose achievements totally undermine the notion that upward mobility can seldom be realized in America.

Those who preach this counterproductive message will probably never think that the envy, resentment and hopelessness they preach, and the welfare state they promote, are among the factors keeping people down.

via The ‘Fairness’ Fraud – Thomas Sowell – Page full.