Is There a Doctor in the House?

by Scheffler, Richard M.

• ISBN13: 9780804700320
• ISBN10: 080470032X
• Edition: 1st
• Format: Hardcover
• Copyright: 2008-09-23
• Publisher: Stanford Univ Pr

Summary

"Will there be a doctor--a good doctor--when I need one?" This is the bedrock health care concern for Americans, encompassing as it does additional concerns about affordability, accessibility, efficiency, and specialty expertise. Richard M. Scheffler brings an economist's insight to the question, showing how shifts in market power underlie the changes we have seen in the health workforce and how they will affect the future availability of doctors. Predicting the "right" ratio of doctors to population in the future is only a small piece of the puzzle, and one that has been the subject of much forecasting, and little agreement, over the past several decades. In this concise and readable analysis, Scheffler goes beyond the guessing game to demonstrate that today's health care system is the product of financial influences in both the policy realm and on the ground in the offices of medical centers, HMOs, insurers, and physicians throughout America. He shows how factors such as physician income, medical training costs, and new technologies affect the specialties and geographic distribution of doctors. Scheffler then brings these findings to bear on a set of predictions for the U.S. and international physician workforce that extend five and ten years into the future. As part of his vision of tomorrow's ideal workforce, he offers a template for enhancing the efficiency and cost-effectiveness of the health care system overall. In the groundbreaking second half of the book, the author, a health policy expert himself, tests his ideas in conversations with leading figures in health policy, medical education, health economics, and physician practice. Their unguarded give-and-take offers a window on the best thinking currently available anywhere. Finally, Scheffler combines their insights with his own to offer observations that will change the way health care's stakeholders should think about the future.

Author Biography

Richard M. Scheffler is Distinguished Professor of Health Economics and Public Policy at the University of California, Berkeley and holds the Chair in Healthcare Markets & Consumer Welfare endowed by the Office of the Attorney General for the State of California.

Table of Contents

Acknowledgments	p. xi
Market Power and the Doctor Supply
The Supply Cycle of Doctors	p. 3
Managed Care Redistributes Market Power	p. 18
Physician Incomes: Following the Money	p. 28
Who Are the Doctors, and Where Are They?	p. 43
Reshaping the Workforce: Nurse Practitioners and Physician Assistants	p. 53
Doctor Supply Forecasts: More or Less	p. 64
The "Right" Number of Doctors in a Better Health Care System	p. 75
Conversations with the Experts
Toward Tiered High-Performance Networks	p. 95
Primary Care and the Medical Home	p. 100
Rethinking the Financing of GME	p. 104
What the Market Signals Are Saying	p. 107
Residents, Payment, and the Global Market	p. 110
Physician Income and the Potential of P4P	p. 112
Measuring Performance: How and Why	p. 116
Paying for Primary Care in an Outmoded System	p. 120
Advanced-Practice Clinicans Challenge Traditional Model	p. 123
Chronic Care Models and Turf Battles	p. 127
Free Medical Education-with Strings	p. 129
Understanding the Real Cost of Medical Education	p. 132
Primary Care: How Much Does Money Matter?	p. 135
A Regional Approach to Health Disparities	p. 137
A Short History of Medical Education and Diversity	p. 140
Too Many Doctors, Too Little Efficiency	p. 143
Taking Responsibility for Generating America's Doctors	p. 149
We Expect Too Much from Physicians	p. 154
The Integrated System: Paying for Primary Care	p. 157
The Declining Role of Government: It's Time to Prepare	p. 161
Tomorrow's Doctors Want Something Different	p. 164
The Medical Home and Other Ways to Save Primary Care	p. 168
External Reporting and Other Keys to P4P	p. 172
What the Business Model and the Military Model Know	p. 175
More Doctors Does Not Equal Better Outcomes	p. 180
Doctors as Team Players	p. 184
Doctors: Stop Being Depressed and Redesign the System	p. 186
A Final Word	p. 191
The Cost of Training a Doctor and the Return on Investment	p. 201
Methodology for Forecasting Doctor Shortages	p. 213
Notes	p. 217
Index	p. 233
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