A SECOND OPINION
This space is for our physician members to speak their minds freely on both medical or non-medical issues of the day and respond to the opinions of others . The GLMS Editorial Board reserves the right to choose what will be published . Please note that the views expressed in A Second Opinion or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine .
Breach The Walls
by MARY BARRY , MD
SECOND OPINION and prospered to help us out .
For too long , medical school admissions have been rationed and now , really scary numbers are showing up . The Economist of Nov . 4 outlined well the hazards of toofew U . S . doctors : we have already reached that point , and primary care residencies have not grown
Austria , Spain and Germany have 4 to 5 doctors for every 1,000 people . Britain and France have 3.5 / 1,000 and we have only 2.5 , most of whom are urban and not rural .
We now have obstetric deserts because of severe abortion ban laws . Even in urban areas of anti-abortion states , doctors have left , frightened of jail time for simply aiding a mother in distress .
ICU nurses in rural ERs are intubating , coding and placing arterial lines and chest tubes with the Zoom-ed advice of actual ER doctors hundreds of miles away . The next problem arises when the nearest Big Hospital is still many miles away and too understaffed to accept the patient . The COVID-19 pandemic not only killed far too many doctors and nurses , but it also led to many early retirements , medical and otherwise .
Since September 1980 , when the Department of Health and Human Services warned of a likely surplus of 70,000 U . S . doctors by 1990 , medical school admissions have shrunk . It did not help when the feds capped federal funding for residency slots . The extremely high cost of medical education has forced many young people into other pursuits .
What is helping the doctor shortage , per The Economist , are the schools of osteopathy . The DOs I ’ ve worked with and the DO students I have taught were indistinguishable to me from MDs and med students . In 1981 , there were only 14 DO schools in the U . S ., and now there are 41 . Currently , 25 % of U . S . medical students are in the DO schools .
The federal cap on fellowship training funds has severely impacted pediatric specialties , in particular .
No matter how many degrees a nurse acquires , unless one of them is DO or MD , he or she has not had the chance to learn to think like a doctor , to examine as thoroughly as a doctor , and thus to develop a differential diagnosis as comprehensive as a doctor ’ s . The wave of APRNs in primary care has resulted in a glut of consults to all sorts of specialists : for instance , to hematology for anemia correctly identified as iron-deficiency , but with the workup stopped there . The next logical step – searching for a site of blood loss – is very rarely taken ; the patient is simply pushed up the ladder to a higher-cost , extremely busy consultant , with resultant delays in treatment due to delayed diagnosis . If the diagnosis is a malignancy , precious time in fighting that cancer has been lost .
If internal medicine teams in the hospital could offer “ visiting student ” status to APRN students needing clinical hours , our APRNs overall would be much better prepared for the sick people
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