What Percent of Doctors Would Do It Again

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July 30th, 2012 past joannamae

by Joanna Mae Souers

*Paraguayan 5th twelvemonth student participating in primary care in Havana, Cuba. (2011,past Joanna Mae Souers)

In early on 2007, I began studying medicine at the Latin American School of Medicine in Havana, Cuba.  I entered the program not knowing much most the Cuban healthcare system, other than that it was universal and free.  "Now that's a system I desire to learn from," I idea to myself, "It's a organisation we could all learn from."  V years afterward, what accept I learned?

There are many subtle and not and then subtle differences between the Cuban and the U.Southward. health intendance systems which accept allowed the Cubans to equal the U.S. with respect to their wellness statistics, just at a much lower toll and with better preventative and master care.  In this newspaper I analyze but one of the reasons for the differences betwixt the ii systems; Republic of cuba produces more than primary care practitioners per capita.  How do they do it? Medical education in Republic of cuba is complimentary, all doctors interested in specializing must commencement serve two years working in chief intendance, and graduating doctors are non driven to specialize by bacon incentives.  This socialist arroyo towards medicine and medical education assures the man resources necessary to provide universal and preventative healthcare to all.

People marvel at how Republic of cuba has "accomplished so much with so piffling."  And they marvel with good reason.  According to the World Health System, Republic of cuba spent simply $503 per capita on healthcare in 2009, the U.Due south. spent almost 15 times that sum.  In fact we in the United states spent $421 per person just on the administration of the individual healthcare insurance organisation, nearly enough to fund the Cuban arrangement. ^{[1] [2]} Despite dramatically lower costs, Cuba has some of the best health statistics and wellness indicators of any country around the world.

Although people like to compare and contrast the health statistics of the U.S. and Cuba, I recall this a chip preposterous.  Republic of cuba, a small-scale island in the Caribbean, is being compared to one of the largest countries in the Americas with a very different history.  And then in the table beneath, I have shown some health statistics on Cuba and the U.Due south. also as the Dominican Democracy and Haiti.  The Dominican Republic and Haiti are Cuba'southward Caribbean neighbors; like in size, history and geographic location.

*Statistical data provided past the Earth Health Statistics 2011 Report by the Globe Health Organization.

From this tabular array, nosotros can meet that Cuba's health indicators are more like those of the "beginning world" in the U.Southward. than its neighbors in the "third earth."  The life expectancy of the U.S. and Cuba is almost identical.  Cuba supersedes the U.S. in the categories highlighted.  And so we go along to inquire, "How practise they exercise it?"  Could information technology accept something to exercise with their philosophy that people need doctors?  Hence, their solution is to offer a free medical educational activity to develop young, quality doctors dedicated to serving those in need.

Per capita Republic of cuba graduates roughly iii times the number of doctors as the U.S.   In 2005 Republic of cuba had 70,594 doctors.  Before the revolution in 1959, there were merely an estimated vi,000 doctors; somewhere around half left the country subsequently 1959.  This ways they must have graduated an average of 1,469 Cuban doctors per yr, not including the some 5,000 international students who graduate each twelvemonth from Cuban medical schools. ^[3] When we later compare these numbers to the U.S. we run across that Cuba graduates 3 times the number of doctors per capita, and the U.S. must import graduating doctors from other countries just to fill the chief care residency positions.

Critics of the "Obama Plan" say that there will not be plenty doctors in the U.S. to take care of all the patients if everyone has healthcare coverage.  Obama encouraged the Association of American Medical Colleges to increase the number of graduating doctors by 30% in 2010.  Ever since 1980, U.S. Medical schools have graduated 16,000 doctors a year.  Meanwhile, the population of the U.S. has grown 50 million during the same period.^[4]  A 30% increment would have meant we should have graduated 20,800 medical students in 2010, but nosotros only graduated 16,838 according to the Kaiser Family Foundation.^[v]  The number of residency programs at teaching hospitals in the U.S. has been frozen since 1997, funded by Medicare.  In that location were 29,890 residency slots filled in 2009,positions not filled past American graduates are filled by International Medical Graduates. ^[4]   This means we tin can estimate more than one/3 of students in U.Due south. residency programs are International Medical Graduates (IMGs), students from another state or a U.S. citizen, like me, who studied in some other country.

In the current scheme of things, International Medical Graduates are continuously brought in to the U.South. to come across the needs of the growing patient population.  Unfortunately zilch bridges the gap, because there simply are non plenty residency positions and/or funding for instruction hospitals to produce plenty doctors to satisfy the entire U.S. population.  Taking International Medical Graduates to meet the needs of the U.S. population just adds to the "brain drain" of developing countries around the world.  So as we produce fewer doctors, introduce more doctors from other countries; U.S. doctors work harder for less to encounter the needs in the U.S. and a lot of the world remains catastrophically underserved.

Cuba leads the world with the lowest patient to dr. ratio, 155:1, while the U.S. trails way behind at 396:one.^[6]  With a surplus of Cuban doctors, Cuba is able to help ailing nations around the globe.  They have medical missions in over 75 different countries atomic number 82 past virtually xl,000 health professionals, well-nigh half of them are doctors.^[7]  The United States past dissimilarity imports doctors from poorer countries, farther contributing to the brain drain of professionals from poorer countries to rich ones.

In Republic of cuba education is gratuitous.  Room and board, books and amenities are included.  Doctors are not burdened by pupil loans and live comfortably though non extravagantly.  Harvard Medical School states in their admissions statement that an "un-married outset twelvemonth medical student" volition spend approximately $73,000 for the 2011-2012 academic year.  This includes tuition, room and board, books, etc.^[8] At present times that past four and y'all have a whopping $292,000 to shell out to become a Harvard medico.  With interest rates, loan deferments and default charges, y'all might stop up like Michelle Bisutti.  She graduated medical schoolhouse in 2003 with a $250,000 debt, in which by 2010 had increased to $555,000.^[nine] This may be an extreme case, but the Association of American Medical Colleges projected in their 2007 study that in 2033, students on a x-twelvemonth repayment plan will just see one-half of their later on-taxes salaries, the rest going to loan repayment.^[10]

The price of medical didactics in the U.S. causes more and more medical school graduates to turn to higher paying specialties and subspecialties rather than primary care or family medicine.  Dr. Thomas Bodenheimer writing for the New England Journal of Medicine, stated that "betwixt 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by l percent," based on data from the National Resident Matching Program. ^[11]  In the U.S. specialists predominate at a ratio of 2:one (the contrary of other Western countries) while half of all outpatient visits are made past master care physicians. ^[12] This deficit of primary care physicians decreases people'due south access to main intendance and preventative medicine, causing increases in wellness disparities and healthcare costs.  This is because preventative medicine benefits the patient as well as reduces the number of Emergency Section visits and infirmary stays.  If there are no master care physicians to provide preventative care to the population, nosotros see the population suffer as costs continue to rise.

* Family Medicine Residency Positions and Number Filled past U.South. Medical School Graduates. From the American Academy of Family Physicians, based on information from the National Resident Matching Program. [11]

Co-ordinate to a survey in 2008 by the American Academy of Family Physicians, family medicine graduates with less than 7 years of experience earn, on average, a yearly salary of $145,000.^[thirteen] The difference in earnings between chief care physicians and specialists differed past merely 30 percentage in 1980, and dramatically rose upwards to 300 percent for some narrowly divers specialists past 2009.  In the graph below, we show the dramatic difference between median compensation for selected specialties compared to that of primary care.^[14,15]

*Median Compensation for Selected Medical Specialties.
Data are from the Medical Group Management Association Medico Compensation and Production Survey, 1998 and 2005. [15]

When working in the U.S., almost every primary care physician I talk to has the same complaint, "Too many patients, and as well fiddling time."  They are forced to encounter 20 to xxx patients a 24-hour interval but to encounter pay-incentives and "keep their doors open up."  General/Family Practise physicians spend an boilerplate of 16.1 minutes with each patient per visit. ^[16]   Meanwhile, 18%, or roughly 48.2 one thousand thousand of the U.S. population nether the historic period of 64 is without healthcare insurance.  They take no access to most GP's or family practice physicians. ^[17]

We need to follow our Cuban role model, we need to be held socially accountable and produce more main care physicians.  This tin be accomplished past providing an education at full scholarship to those interested in primary care, or past increasing the number of medical students going into primary intendance past endmost the compensation gap betwixt primary intendance and the college paid specialties.  These measures would ensure the population better access to quality main care and preventative medicine.  It would bring down the cost of healthcare while allowing chief care physicians to do nether less stressful atmospheric condition leading to quality affordable healthcare for all.

1. World Wellness System (WHO 2011); Countries. [world wide web.who.int/countries/en]
2.  "Healthcare Marketplace Project, Trends and Indicators in the Changing Marketplace (Exhibit vi.11: Private Health Insurance Admin Cost per Person Covered, 1986-2003)," Kaiser Family unit Foundation, Publication Number: 7031.  [http://www.kff.org/insurance/7031/print-sec6.cfm]
3.  "Republic of cuba and the Global Wellness Workforce: Preparation Homo Resources." Salud! (Source Vice Ministery for Medical Instruction and Enquiry, Ministry of Public Health) [http://world wide web.saludthefilm.internet/ns/elam.html]
4. Sullivan, Paul.  "Discomfort at U.South. Medical Schools." The New York Times; April 29, 2009.
5.  "Total Number of Medical School Graduates, 2010."  The Kaiser Family Foundation.  [http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8]
6.  "World Health Statistics 2011," World Health System; WHO Press, Switzerland.
7. Brouwer, Steve.  "The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity," Monthly Review, 2009, vol 60, result eight (Jan).
8. Harvard Medical School Admissions, "Costs (Updated: 7/21/2011)."  [http://hms.harvard.edu/admissions/default.asp?page=costs]
9. Pilon, Mary.  "The $555,000 Pupil Loan Burden," The Wall Street Periodical, February 13, 2010.
10. Fuchs, Elissa.  "With Debt on the Ascent, Students Face an Uphill Battle." The Clan of American Medical Colleges, January 2008.
11. Bodenheimer, Dr. Thomas,"Primary Care – Volition it Survive?" New England Journal of Medicine, vol 355;9. Pg 861-862.
12. Alper, Philip R. "Primary Intendance's Dim Prognosis," Hoover Establishment, Stanford University, Policy Review No. 158 (Dec one, 2009).
13. American University of Family Physicians, Income (2011).      [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/graduation/income.html]
14. Alper, Philip R. "The Decline of the Family Doctor," Hoover Establishment, Stanford University, Policy Review No. 124 (Apr one, 2004).
15. Woo, Dr. Beverly.  "Primary Care – The Best Job in Medicine?" New England Journal of Medicine, vol 355;9. Pgs 864-866.
16.  "Healthcare Market Project , Trends and Indicators in Changing Healthcare Market (Exhibit 6.5: Hateful Fourth dimension Spent with Physicians (in Minutes), 1989 – 2002),"  Kaiser Family Foundation, Publication Number: 7031, Data Updated: 4/11/05.      [http://www.kff.org/insurance/7031/impress-sec6.cfm]
17.  "2010 National Wellness Interview Survey (Tables one.1A-B, 1.ii B)", Eye for Disease Control.  [http://www.cdc.gov/nchs/fastats/hinsure.htm]

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Source: http://www.socialmedicine.org/2012/07/30/about/cuba-leads-the-world-in-lowest-patient-per-doctor-ratio-how-do-they-do-it/

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