Life Extension Magazine March 2013
As We See It
The Looming Doctor Shortage
By William Faloon
Government regulation results in high prices, poor quality, and lack of innovation.
A frequent complaint in the most regulated economies (i.e. communistic) is persistent shortages of everything.
When government exerts absolute control, waiting in line for essentials become routine events. In extreme cases the outcome is famine, such as has occurred in North Korea in recent times.
For some bizarre reason, some Americans still believe that difficult problems can be solved if government enacts more regulations.
The problem is that today’s over-regulated healthcare system has grown so expensive that the average person cannot afford it. Nor can businesses or governments.
Instead of repealing regulations that cause sick-care costs to be so dreadfully overpriced, the federal government thought that by writing 900+ pages of new regulations (The Affordable Care Health Act), the problem would go away.1
We at Life Extension® have a 33-year track record of predicting future medical-related events. Our early warnings about over-regulation were ignored. The result is that sick-care costs are a major factor behind individual, business, and government insolvencies.
This article discusses the coming physician shortage, what can be done to reverse this deadly trend, and how you can reduce your odds of becoming a victim.
Economic Truths Ignored
As the population ages, demand for medical services is sharply escalating. Little has been done, however, to provide a corresponding increase in supply.
Increased demand without additional supply equals shortages.
When it comes to shortages of medical services, the tragic result is needless suffering and death.
The Affordable Care Health Act, which is supposed to provide virtually every American with medical coverage, is now coming into force. But no one knows where the physicians will come from to treat these “newly insured” individuals.2In many parts of the country, hoards of the newly insured, along with people who are merely growing old, are creating severe physician shortages.1
Doctor Shortages Not a New Problem
People exposed to conventional healthcare are aware that most doctors lack the time to provide optimal care. This is evidenced by delays in getting appointments, jammed waiting rooms, and long hold-ups in exam rooms.
Some physicians aren’t taking new patients, while others crowd whoever calls into a clogged schedule that does not allow sufficient time to treat each patient.
You can drive your car in for a “10-minute oil change,” but you are unlikely to get that much time with most physicians, even though your life may be on the line.
As more scientific advances occur in the medical arena, the inability of physicians to devote enough time with their patients will result in greater numbers of tragic outcomes.
Warnings of physician shortages are no longer confined to the pages of this magazine. These dire predictions are now coming from the medical establishment itself!
The Frightening Numbers
The Association of American Medical Colleges estimates that within two years the United States will have 62,900 fewer doctors than needed. By 2025, the shortfall of doctors will exceed 100,000.3
Mainstream experts, including many who supported the Affordable Care Health Act, say there is little that anyone can do to close the gap as the law will extend coverage to over 30 million Americans.1
It typically takes a decade to train a doctor. Even if medical schools significantly increased enrollment, they would not come close to generating enough physicians to treat the newly insured and the rapidly aging population.
High tuition costs, stringent academic requirements, and brutal internships create barriers that limit the supply of new doctors. The Harvard School of Medicine, for example, accepts only 165 new admissions each year, and not all these students graduate into medical practice.4
Some in the mainstream describe a doctor shortage as an “invisible problem.” Patients still get care, they say, but the process is often slow and difficult. It can force patients to drive long distances, languish on waiting lists, overuse emergency rooms and even forgo care. Those who delay treatment place an even greater future burden on what is an already broken sick-care system.
Even more ominous for many of the “newly insured” is that since 2008, more than 50% of primary care doctors have stopped accepting new Medicaid patients.3 The consequence will be that certain patients entitled to free healthcare may not find a willing physician.5To avoid this looming catastrophe of doctor shortages, radical changes must be made in the way sick-care is dispensed in the United States.
Free Market Solutions
The media is turning these “doctor shortages” into headline news stories and stating the problem is unsolvable.
Those involved in preventive medicine have long known that a combination of poor lifestyle choices and an aging population would create shortages of all kinds of medical services. The Affordable Care Health Act only accelerates this impending health disaster.
I have written three books and authored dozens of articles that describe the ominous shortage of competent medical care and how this can be resolved through free market regulatory reform. It is somewhat encouraging that even the FDA is considering some of changes we at Life Extension advocated more than thirty years ago.
For example, many medicines that currently require a physician’s prescription can be safely dispensed by pharmacists, thereby eliminating the need for doctors to squander their time on minor problems. In other cases, empowered patients could access reliable websites or telephone help lines that could suggest lower-cost versions to what now are prescription-only drugs.
Pros Versus Cons of Self-Prescribing
One can always come up with cynical scenarios whereby an uninformed patient will inappropriately self-prescribe a drug and suffer an adverse outcome.
We have argued the opposite, i.e. an empowered patient can self-prescribe certain medications more effectively than with conventional physician oversight.
Let’s look at hypertension, which is one of the most under-treated diseases in the modern world. Those who fail to keep their blood pressure in optimal ranges suffer sharply higher rates of stroke,6-8 heart attack,9,10 and kidney failure.11-14
Hypertension is often described as a “silent killer” because it seldom produces symptoms. Conventional medicine relies on doctor’s offices to check every patient’s blood pressure to identify those who are hypertensive. Doctors should recognize any reading above 115/75 as a cause for concern and recommend lifestyle changes (such as losing weight) and/or initiate treatment with an anti-hypertensive medication.15,16
The reality is that doctors today don’t usually worry about their patient’s blood pressure until it reaches 140/90—a dangerously high level. Most doctors will prescribe blood pressure medication and instruct the patient to return for a follow up. The patient may or may not fill the script. If the drug causes an unpleasant side effect, the patient may discontinue it and not go back to the doctor.17
Even if a patient is compliant in losing some weight and taking their medication, they may not know if they are achieving optimal 24-hour blood pressure control. They may, for instance, take their blood pressure pill in the morning and see their doctor a few hours later. The patient’s blood pressure might be fine that hour, but as the drug wears off, they may spend more than half their day in dangerously high ranges.18
What if instead a national alert were made about the shortage of doctors and that patients will be responsible for taking care of mostly manageable conditions such as hypertension. Every household (or community) would be instructed to purchase an at-home blood pressure monitoring device (they cost less than $80). Twice a day monitoring would be advised until blood pressure is brought down to optimal ranges through lifestyle changes, supplements and/or drugs that could be purchased over-the-counter.
If one drug caused an unpleasant side effect, another could be immediately tried. Consulting with a pharmacist would assist in identifying an effective, side-effect free anti-hypertensive drug for virtually everyone. The minority with refractory hypertension that fails to respond to lifestyle changes and simple drug therapy should of course see a doctor, who may prescribe multiple medications to reduce blood pressure.
If blood pressure drugs were allowed to be sold without a prescription, and the public notified that controlling their blood pressure was one of individual responsibility, I foresee a drop in hypertension-induced illnesses, huge reductions in sick-care costs, and an alleviation of the pending doctor shortage. With waiting rooms cleared of hypertensive patients, doctors would have more time to spend with those who have serious problems.
Under this free market reform, I envision private companies forming that would sell at-home blood pressure monitors and an array of low-cost blood pressure medications. These companies would provide hypertension advisors who would be trained to suggest medications to try based on one’s blood pressure readings and other variables. Even more efficient would be entering at-home blood pressure readings on to websites that would automatically suggest the best medication(s) and lifestyle changes.
The Real World…
Pessimists raise all kinds of fearful concerns when it comes to people taking charge of their own health. What goes on in the real world, however, validates this free market approach to resolving the doctor shortage while enabling improved overall outcomes (meaning fewer strokes, heart attacks, and failed kidneys).
I have owned an at-home blood pressure monitor for many years. It enables me to achieve precise blood pressure control. I sometimes go days without having to take a blood pressure medication.
If I relied on doctors, I would not have known that the drug I had initially used was only providing me with about 12 hours of blood pressure control. If I relied only on doctors, I would later be taking a high-dose anti-hypertensive drug every day, even though on most days I don’t need it. (My blood pressure continues to drop as I lose weight...one of the benefits of calorie restricting.)
I have let dozens of people use my at-home blood pressure monitor. About half are hypertensive, yet only one person ever bothered making a doctor’s appointment and she went through a lot of hassles to get insurance to cover it.
If these hypertensive individuals were able to walk into a pharmacy and ask for a low-cost generic drug like losartan, I’m certain most of them would have done it.
The hassles of finding a doctor, setting up an appointment, waiting hours to see the doctor, dealing with one’s insurance (or paying out of pocket), dropping off the prescription at the pharmacy, then coming back to pick up the prescription causes too many people to ignore asymptomatic diseases like hypertension.
A one-month supply of losartan (sixty 50 mg tablets) if sold in a free market would cost less than $14 a month. This makes blood pressure control “affordable” to virtually everyone. Many pharmacies have blood pressure monitors for public use, so even if one cannot afford their own monitor, they could still achieve optimal blood pressure control.
The role of “individual responsibility” is significant as any drug can have side effects and there are certain people who should not take losartan such as pregnant women or women who may become pregnant. This information is instantly available on the Internet, so part of this kind of individual responsibility mandate is for people to spend a little time reading about any medication they decide to self-prescribe.
Naysayers to this free market approach overlook the impending shortage of doctors, the fact that most doctors aren’t adequately controlling their patients’ blood pressure and that hypertension remains a leading preventable cause of death.19 They also ignore the epidemic of hypertension-induced disability (despite universal screening in doctor’s offices) and the fact that America cannot afford the inflated costs of over-regulated sick care, despite federal mandates that virtually everyone now be “insured.”