I have not had time for an extensive Q&A, but this question deserves some ranting.
I would still be interested in your input regarding my earlier comment on your post on Quality Medical Care. Recent experiences of my own make me doubt that healthcare is even as rational as “rationed by ability to pay.” I have excellent health insurance and the ability to pay out of pocket for what I need, but here in Boston it is virtually impossible to get a doctor’s appointment with a GP or an obstetrician (forget about a specialist), even when I tell them I’m recovering from a pulmonary embolism that landed me in the hospital. Is there a doctor shortage? If so, money doesn’t appear to move you to the front of the line. What is going on? No one seems to know, or at least want to discuss it.
Amazingly, I do think we have a doctor shortage. The shortage is subtle, but known to most practicing physicians. It differs among specialties.
I am often asked to help someone find a physician. Despite working in a major academic medical center, I find this a difficult task. Access seems no better in the private sector.
We need more first contact physicians – internists, family physicians, and obstetricians. Obstetricians are leaving practice secondary to malpractice costs. Internists and family physicians are leaving for the reasons that I state almost weekly. Overhead continues to increase while reimbursement is either flat or decreasing.
From the physician viewpoint, medical care does not work as a free market. Our patients get first preference of our time. Eventually you fill your practice and no longer take new patients.
I know that this does not make sense. It seems counterintuitive to me. We have often little incentive to accept an additional patient. Patient care is suffering – and ability to pay (while a factor) does not necessarily help one find a physician.
I expect some excellent comments from my physician readers.