Published in: San Jose Mercury News, Wednesday, November 7, 2001, page 11B:

"Federal Rules Create Looming Physician Shortage".

by Donald J. Prolo, M.D., President
Western Neurosurgical Society


"Nine-year-old Stefan scrambled for candies under the pinata when a thunderous blow fractured his skull. A blind-folded older celebrant at a Sunday birthday party missed his target, but not Stefan's head.

Four hours later, Stefan's pupil was fixed and dilated. A drowsy, off-call neurosurgeon, exhausted from a previous all-night operation, was begged to help this dying child with an enlargening epidural hematoma. No other surgeon was available.

Was this a scene from a third-world country? No. It occurred in Santa Clara County, Silicon Valley, the Capital of the Digital Global Economy, home to three major universities, countless occupational and recreational opportunities, a nonpareil climate, and the highest housing and living costs in the United States.

Medicine is in free fall here and in the rest of California. Two recent surveys predict the mass exodus of over half the population of practicing physicians over the next three years. Nearly 400 physicians responded to a county medical association survey reported early this year: 62 percent will retire, relocate, or retrain for other occupations within the next three years; 86 percent are unable to induce physicians to join their practices; 97 percent indicated current regulations and reimbursement hurt the quality and availability of primary care and specialty physicians.

On July 16, the California Medical Association released "And Then There Were None -- the Coming Physician Supply Problem." Responses from over 2,300 physicians in the state replicated the Santa Clara County report: 43 percent of surveyed physicians plan to leave medical practice in the next three years. Another 12 percent will reduce time spent in patient care.

The federal government has brought about this monumental crisis in availablity of medical care. Consider:
 

  • Price controls were introduced in Medicare in 1984 and increased in the 1990s. Simultaneously the federal      government allowed price-fixing by insurers; private insurers could form large cartels to purchase services from physicians at levels below what would prevail in a competitive market.
  • As of October 2000, physicians must comply with 132,000 pages of Medicare and Medicaid regulations. This burdensome and complicated edict includes six criminal and four civil and administrative statutes. Imprisonment up to 20 years and fines of thousands of dollars are stipulated for "fraud and abuse". A hotline number was established to encourage whistle-blowers.
  • A 1986 law enacted in response to a concern that indigent and uninsured patients were not being treated led to another legion of regulations and fines, up to $50,000 per violation.


    • Costs of compliance with these laws increase practice expenses and further reduce the margin for viability of a practice. At the same time, costs of living rise. Graduating MDs face these barriers, along with average incurred student loan debts of more than $100,000.

    The federal government has created this crisis. If it strikes again at the pinata of medicine, perhaps medicine will break and the wonders of modern care and cure will dissipate, lacking the innovators and caregivers of a now-dispirited profession.

    Will the people blow the whistle on the federal government? Or will they tolerate this progressive evisceration of the medical profession?

    Stefan lives. Who will care for other Stefans in three years?"


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