How did we get here? The high cost of medical school is one culprit. Median debt for new doctors is $200,000 after four years of expensive post-graduate education, so it’s no wonder that American medical students lean toward narrow and high-paying specialties rather than primary care. The average salary for orthopedists and plastic surgeons is nearly $500,000, as opposed to $230,000 for internal medicine. Doctors also gravitate toward cities, leaving chunks of the country under-served. Making things worse, a cap on federal funding of residency programs instituted in 1997 limited the pipeline of new doctors, contributing to a smaller population of physicians that are on the older side.
All health care workers are at risk of contracting the disease, reducing the numbers available to treat the sick, and older physicians will be at higher risk of becoming patients themselves. As Covid-19 spreads, hospitals are likely to need all hands on deck. While some specialists will be crucial, others will need to care for the sorts of patients they may not have seen since their training.
In the long run, the public sector needs to do more to boost the number of young generalists. Paying a substantial portion of tuition would go a long way, as would finding ways to close the pay gap for physicians who choose that path. This should be coupled with big subsidized boosts to residency programs and medical-school class sizes. Some American medical schools offer three-year training, a development that should be further encouraged.
These steps won’t help in the current crisis; for that, more immediate action is warranted. On Wednesday, Vice President Mike Pence announced a new regulation that will allow doctors and medical professionals to practice across state lines, which could help with acute shortages. If the virus continues to spread nationwide, however, loosened rules won’t be enough.
New York governor Andrew Cuomo is reaching out to retired doctors and nurses as well as medical and nursing schools to bolster the state’s workforce. The school initiative is worth exploring on a larger scale. Those willing to delay their education and work in areas hard hit by the virus or short on doctors should get substantial debt relief. This recruitment will be expensive and disruptive, and the students will need supervision. But if it can ease looming staffing shortages and add an infusion of youth, it’s worth it.
Efforts to add staff need to be paired with steps to make things easier on those fighting the outbreak right now. The biggest priority is keeping people out of the hospital to make sure institutions and physicians aren’t overwhelmed.
There’s been a recent step forward in terms of social distancing guidelines in the U.S., but it’s worth considering broader quarantines to slow spread in hard-hit areas. Expanded outpatient and drive- or walk-through testing will be essential as well. The message that most people are better off staying at home to prevent infection or recover needs constant and broad repetition; hospitals need to be dedicated to treating seriously ill patients. Dr. Jeremy Faust, a public-health focused emergency room physician, also suggests in a Washington Post editorial that the government temporarily relax legal medical malpractice standards. Doing so could help physicians focus on severely ill patients and keep beds free without worrying about legal risk.
Within hospitals, shortages of protective equipment need fixing, and omnipresent physician paperwork burdens can’t hold up the ability to treat patients in a crisis. Outside those doors, funding and space for child care is needed now that schools are closed in many areas. The same goes for providing comfortable and affordable places for health care workers to stay who need to be quarantined or don’t want to put their families at risk.
It’s going to be a difficult few months for those working in American hospitals. The sooner broad and inventive measures are put in place to help, the better.
This column does not necessarily reflect the opinion of Bloomberg LP and its owners.
Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.
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