ON NOVEMBER 4, 2014 DR. BILL KELLY, PROFESSOR OF MEDICINE, BIOCHEMISTRY AND BIOPHYSICS at the University of Pennsylvania spoke at the Vero Beach Trinity Episcopal Church’s popular Lecture Series about various healthcare reforms. Dr. Kelly is the founder of Hippocrates 2.0, an effort to plan, develop and design a new method of health care delivery.
Dr. Kelly refers to healthcare as an ecosystem, a complex network or interconnected system. He said that one of the biggest burdens on our healthcare system is the escalating costs to administer it.
Hippocrates 2.0 has ten core principles on which to reform healthcare.
1. Improve human health
2. Patient centered care
3. Value driven healthcare
4. Population-based care
5. Patient Access
6. Cost conscious behavior
7. Medical liability reform
8. Research funding and training
9. Precision/personalized medicine
10. Digital health transformation
The most riveting issue about Dr. Kelly’s remarks was the issue of doctor shortages. According to the Association of American Medical Colleges (AAMC), “the United States faces a shortage of more than 130,600 physicians by 2025,” equally split among primary care and specialities such as cardiology, oncology and neurosurgery. The shortage reported by AAMC in 2015 is 62,900.
One of the problems of doctor shortages is that in the 1997 through the Balanced Budget Act Congress capped the number of federally funded residency training programs. The current level of 26,000 residency positions is not enough to provide training for medical school graduates as early as 2016.
Members of the US Senate and House of Representatives need to act and lift the cap to be sure there are enough doctors for the growth of our aging population.
With respect to the State of Florida, a 2005 report by the Board of Governors of the State University System of Florida noted that: “though data sources are conflicting, the exact number of physicians that will be needed outstrips production. A quarter of Florida’s practicing physicians are over age 65 and only 35% are under 35…Florida’s population is projected to increase 60% by 2030 and the aged population is expected to grow by 124% in that same span.”
With regards to Vero Beach and the Indian River Medical Center (IRMC) in particular, in past conversations with Dr. Richard Milsten, a preeminent urologist and advisor to IRMC President/CEO Jeff Susi, without the philanthropy generated by the Indian River Medical Center Foundation, IRMC would not have its Heart Center and newly launched Scully-Welsh Cancer Center. He believes these new centers are critical to attracting outstanding physicians to IRMC in the face of the National issue of doctor shortages.
A September 5, 2014 article in the OP-ED section of the New York Times by Pranay Sinha was particularly disturbing. Dr. Sinha is a physician in his first year of residency in the department of internal medicine at Yale-New Haven Hospital.
According to Dr. Sinha, “The statistics on physician suicide are frightening: Physicans are more than twice as likely to kill themselves as non-physicians (and female physicians three times more likely than their male counterparts). Some 400 doctors commit suicide every year. Young physicians at the beginning of their training are particularly vulnerable: In a recent study, 9.4 percent of fourth-year medical students and interns – as first year residents are called – reported having suicidal thoughts in the previous two weeks.”
Further, he says: “There is a strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional and physical prowess beyond what we truly possess.” Additionally, “Most fourth-year medical students are expected to take care of four patients at a time. But within a month of graduation, without any additional training or practice, we are required to have a comprehensive understanding of up to 10 patients on any given day.”
Doctor Shortages: A bad situation gets worse.