Kentucky is getting behind

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The Kentucky Post reports, “State facing doctor shortage.” Right now there are 213.5 physicians for every 100,000 people, while the national average is 267.6/100,000. It is interesting to see the report’s list of reasons.

Doctors are retiring earlier.

More doctors are entering administrative medicine rather than treating patients.

The threat of litigation and difficulty of dealing with managed care has affected physician ranks.

The need for more physicians also is growing as the population ages and as more people can afford more care.

“The Centers for Disease Control reports that hospital and doctor visits have surged by 20 percent over the past five years,” the report said.

Some observations. First, notice that there is only one reason offered that explains the shortage. The rest are simply statements about how the shortage is happening. What I mean is this:

Why are doctors retiring earlier? It doesn’t explain anything to say they are doing this. We need to know why they are retiring and why they aren’t being replaced at the same rate as retired doctors were replace in previous years. So likewise:

Why are doctors entering administrative medicine rather than treating patients?

Why isn’t the increased demand translating into more doctors? This bothers me more than anything else. How can the fact that more people can afford more doctors be an explanation as to why there is a shortage? It should work in exactly the opposite way. Likewise, a surge in hospital visits should provide incentive to expand more hospitals.

So in the list, the only real possible cause is this: “The threat of litigation and difficulty of dealing with managed care has affected physician ranks.”

Since this is a medmal blog my first instinct is to latch on to the medical malpractice explanation. And I’m sure that is a factor. But until someone really investigates I can’t be sure if it is any more important than the “managed care” explanation. I wouldn’t be surprised to learn that doctors are effectively becoming subject to price controls and are finding they can’t make it in practice. But, then again, there may be some other factor.

Still, there are plenty of other cases of shortages (mammogram readers, for example) where we have direct evidence of liability worries causing shortages. It is hard to believe that it is not affecting Kentucky.

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