Highlights
Task:
The practice of medicine, long valued for individual entrepreneurship and physician control, has undergone dramatic change. Physicians now face vexing oversight of case and utilization management and loss of control over the allocation of health care dollars. Managed care organizations control health costs by arbitrarily refusing reimbursement for certain medical procedures and reducing payments for others.
Since medicine is now a less attractive career option, will fewer high performing individuals choose to become physicians? What are the implications for the quality of care? llistorically, there was an extensive argument in medicine between physician-controlled allocation of health care dollars versus insurance determination of costs of services and physician reimbursement (Sulu & Kroth, 2018). In the 1990s and early 2000s, there was significant evolution of the managed care organization from health maintenance organizations (HMO) later refined to preferred provider organizations (PPO), which was pan of a long-term shift from physician control to insurance determined costs and reimbursement. Experienced physicians witnessed these dramatic changes. which could have made medicine a less attractive career option and caused some physicians to retire contributing to a potential multifactorial physician shortage; however, new physicians would not have witnessed these changes and would begin their careers with fresh perspective. According to the U.S Bureau of Labor Statistics' Occupational Outlook Handbook, projected growth for physicians will be 4 percent through 2029. similar to all occupations, but does this projected growth consider the experienced physicians exit from medicine with transition into retirement? Unfortunately, further statistical and predictive analysis were extraneous and outside of the scope of this discussion. Sultz and Kroth (2018) described multiple instances of actions the federal and state governments took to protect against physician shortage. For example, during the 1970s, foreign trained physicians were encouraged to practice in the United States, and medical schools doubled their capacity. These same issues were described by Ahmed and Camiody (2020). They postulated that graduate medical education would need to be expanded to accommodate graduates of allopathic, osteopathic, and international medical schools that require one year or more of postgraduate residency to obtain licensure. While this would help to fill vacancies left by exiting experienced doctors, quality of care and safety could be impacted because of this exodus. Therefore, it would be in the best interest of the country to anticipate and mitigate barriers, encouraging continued career planning for future physicians.
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