Posted on by Californiacontrarian

Especially in California

If you are going to be sick, you better do it soon, especially if you live in California. I say this because if you wait too long, there may not be the doctors to take care of you, especially if you live in California.

A recent study has predicted a shortage of 40,800 – 104,900 physicians in the U.S.A. by 2030. This shortage will be felt in both urban and rural areas, and will effect both primary care and sub-specialties. Nurse practitioners and physician assistants will help, but they are not qualified to deliver the exact same services. If there is going to be such a shortage by 2030, why not just open up the spigots and increase the number of physicians being trained in order to satisfy the growing need? Unfortunately caps were placed on Medicare funding for residency training about twenty years ago, and these caps make it very difficult to expand graduate medical education. Okay, so there is going to be quite a shortage of physicians in thirteen years, but why?

The answer involves retiring older physicians, newly trained younger physicians, and some “basic economics.” Part of the problem is that older physicians seem to be retiring at an increased rate. One factor here is burnout, and according to the Maslach Burnout Index, this is due to a combination of six factors – workload, control, rewards, community, fairness, and values conflict. This burnout problem is intensified by the excessive use of Electronic Health Records, which is negatively affecting physician well being. The most recent data indicates physicians are spending about the same amount of time each day in front of the computer screen as they are with face-to-face patient contact. These days when older physicians are financially able to retire comfortably, they just say,  “Show me the door!”

Okay, so what is the problem with the supply of newly trained physicians, and why should they be less apt to practice in California? This is where “basic economics” comes in.

First of all the cost of living is higher in California than in many other places in the country, and this assuredly includes the cost of housing. A friend of mine recently left California because he and his wife concluded that they would never be able to afford a house in California, and now they have a house and are quite happy in Texas.

Second, most new physicians these days are coming out of med school with significant, and sometimes overwhelming debt. Paying off this debt is a major undertaking as the interest on this debt is constantly churning! For the sake of discussion let’s assume that the newly trained physician owes $200,000 because of college and med school loans, and let’s also assume that he/she can potentially earn $200,000 per year. (Both of these figures are not far from what the averages are these days.) Why should the new physician, possibly now with a wife/husband and a young family want to settle in a state that has the highest state income tax in the country? Why should he/she pay $20,000 in state income tax when that same $20,000 could be used to pay down the school loans? If this newly trained physician settles in California, it could take 10-20 years to escape the burden of that debt – remember that the interest continues to pile up as long as there is still any balance due on the loan. So if you were a young M.D., would you rather live in a small rental in an area with a good climate, or live comfortably in your own house in a state other than California?  Duh!!

Third, all of this so far is without the extra burden of “single payer health insurance” coming soon to a liberal Democratic state near you soon – i.e. . . . California! (This is a topic that will be a disaster for practicing physicians in California and will need an entire blog all to itself to discuss.)

I rest my case.

Trouble is a comin’.

Again I say, “If you are going to be sick, you best do it soon, especially if you live in California!”

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