Life Extension Magazine®

Issue: Mar 2013

The Looming Doctor Shortage

Today’s over-regulated healthcare system has grown so expensive that the average person cannot afford it. Nor can businesses or governments. A new law is supposed to provide virtually every American with medical coverage. But no one knows where the physicians will come from to treat 30 million newly insured individuals. Find out about the looming physician shortage, how to reverse this deadly trend, and what you can do to reduce your odds of becoming a victim.

By William Faloon.

William Faloon
William Faloon

Government regulation results in high prices, poor quality, and lack of innovation.

A frequent complaint in the most regulated economies (i.e. communistic) is persistent shortages of everything.

When government exerts absolute control, waiting in line for essentials become routine events. In extreme cases the outcome is famine, such as has occurred in North Korea in recent times.

For some bizarre reason, some Americans still believe that difficult problems can be solved if government enacts more regulations.

The problem is that today’s over-regulated healthcare system has grown so expensive that the average person cannot afford it. Nor can businesses or governments.

Instead of repealing regulations that cause sick-care costs to be so dreadfully overpriced, the federal government thought that by writing 900+ pages of new regulations (The Affordable Care Health Act), the problem would go away.1

We at Life Extension® have a 33-year track record of predicting future medical-related events. Our early warnings about over-regulation were ignored. The result is that sick-care costs are a major factor behind individual, business, and government insolvencies.

This article discusses the coming physician shortage, what can be done to reverse this deadly trend, and how you can reduce your odds of becoming a victim.

Economic Truths Ignored

Portrait of stern looking doctor  

As the population ages, demand for medical services is sharply escalating. Little has been done, however, to provide a corresponding increase in supply.

Increased demand without additional supply equals shortages.

When it comes to shortages of medical services, the tragic result is needless suffering and death.

The Affordable Care Health Act, which is supposed to provide virtually every American with medical coverage, is now coming into force. But no one knows where the physicians will come from to treat these “newly insured” individuals.2

In many parts of the country, hoards of the newly insured, along with people who are merely growing old, are creating severe physician shortages.1

Doctor Shortages Not a New Problem

People exposed to conventional healthcare are aware that most doctors lack the time to provide optimal care. This is evidenced by delays in getting appointments, jammed waiting rooms, and long hold-ups in exam rooms.

Some physicians aren’t taking new patients, while others crowd whoever calls into a clogged schedule that does not allow sufficient time to treat each patient.

You can drive your car in for a “10-minute oil change,” but you are unlikely to get that much time with most physicians, even though your life may be on the line.

As more scientific advances occur in the medical arena, the inability of physicians to devote enough time with their patients will result in greater numbers of tragic outcomes. 

Warnings of physician shortages are no longer confined to the pages of this magazine. These dire predictions are now coming from the medical establishment itself!

The Frightening Numbers

The Association of American Medical Colleges estimates that within two years the United States will have 62,900 fewer doctors than needed. By 2025, the shortfall of doctors will exceed 100,000.3

Mainstream experts, including many who supported the Affordable Care Health Act, say there is little that anyone can do to close the gap as the law will extend coverage to over 30 million Americans.1

It typically takes a decade to train a doctor. Even if medical schools significantly increased enrollment, they would not come close to generating enough physicians to treat the newly insured and the rapidly aging population.

High tuition costs, stringent academic requirements, and brutal internships create barriers that limit the supply of new doctors. The Harvard School of Medicine, for example, accepts only 165 new admissions each year, and not all these students graduate into medical practice.4

Some in the mainstream describe a doctor shortage as an “invisible problem.” Patients still get care, they say, but the process is often slow and difficult. It can force patients to drive long distances, languish on waiting lists, overuse emergency rooms and even forgo care. Those who delay treatment place an even greater future burden on what is an already broken sick-care system.

Even more ominous for many of the “newly insured” is that since 2008, more than 50% of primary care doctors have stopped accepting new Medicaid patients.3 The consequence will be that certain patients entitled to free healthcare may not find a willing physician.5

To avoid this looming catastrophe of doctor shortages, radical changes must be made in the way sick-care is dispensed in the United States.

Free Market Solutions

working surgeon in operation room  

The media is turning these “doctor shortages” into headline news stories and stating the problem is unsolvable.

Those involved in preventive medicine have long known that a combination of poor lifestyle choices and an aging population would create shortages of all kinds of medical services. The Affordable Care Health Act only accelerates this impending health disaster.

I have written three books and authored dozens of articles that describe the ominous shortage of competent medical care and how this can be resolved through free market regulatory reform. It is somewhat encouraging that even the FDA is considering some of changes we at Life Extension advocated more than thirty years ago.

For example, many medicines that currently require a physician’s prescription can be safely dispensed by pharmacists, thereby eliminating the need for doctors to squander their time on minor problems. In other cases, empowered patients could access reliable websites or telephone help lines that could suggest lower-cost versions to what now are prescription-only drugs.

Pros Versus Cons of Self-Prescribing

One can always come up with cynical scenarios whereby an uninformed patient will inappropriately self-prescribe a drug and suffer an adverse outcome.

We have argued the opposite, i.e. an empowered patient can self-prescribe certain medications more effectively than with conventional physician oversight.

Let’s look at hypertension, which is one of the most under-treated diseases in the modern world. Those who fail to keep their blood pressure in optimal ranges suffer sharply higher rates of stroke,6-8 heart attack,9,10 and kidney failure.11-14

Hypertension is often described as a “silent killer” because it seldom produces symptoms. Conventional medicine relies on doctor’s offices to check every patient’s blood pressure to identify those who are hypertensive. Doctors should recognize any reading above 115/75 as a cause for concern and recommend lifestyle changes (such as losing weight) and/or initiate treatment with an anti-hypertensive medication.15,16

The reality is that doctors today don’t usually worry about their patient’s blood pressure until it reaches 140/90—a dangerously high level. Most doctors will prescribe blood pressure medication and instruct the patient to return for a follow up. The patient may or may not fill the script. If the drug causes an unpleasant side effect, the patient may discontinue it and not go back to the doctor.17

Even if a patient is compliant in losing some weight and taking their medication, they may not know if they are achieving optimal 24-hour blood pressure control. They may, for instance, take their blood pressure pill in the morning and see their doctor a few hours later. The patient’s blood pressure might be fine that hour, but as the drug wears off, they may spend more than half their day in dangerously high ranges.18

What if instead a national alert were made about the shortage of doctors and that patients will be responsible for taking care of mostly manageable conditions such as hypertension. Every household (or community) would be instructed to purchase an at-home blood pressure monitoring device (they cost less than $80). Twice a day monitoring would be advised until blood pressure is brought down to optimal ranges through lifestyle changes, supplements and/or drugs that could be purchased over-the-counter. 

If one drug caused an unpleasant side effect, another could be immediately tried. Consulting with a pharmacist would assist in identifying an effective, side-effect free anti-hypertensive drug for virtually everyone. The minority with refractory hypertension that fails to respond to lifestyle changes and simple drug therapy should of course see a doctor, who may prescribe multiple medications to reduce blood pressure.

If blood pressure drugs were allowed to be sold without a prescription, and the public notified that controlling their blood pressure was one of individual responsibility, I foresee a drop in hypertension-induced illnesses, huge reductions in sick-care costs, and an alleviation of the pending doctor shortage. With waiting rooms cleared of hypertensive patients, doctors would have more time to spend with those who have serious problems.

Under this free market reform, I envision private companies forming that would sell at-home blood pressure monitors and an array of low-cost blood pressure medications. These companies would provide hypertension advisors who would be trained to suggest medications to try based on one’s blood pressure readings and other variables. Even more efficient would be entering at-home blood pressure readings on to websites that would automatically suggest the best medication(s) and lifestyle changes.

The Real World…

doctor checking the blood pressure of a patient  

Pessimists raise all kinds of fearful concerns when it comes to people taking charge of their own health. What goes on in the real world, however, validates this free market approach to resolving the doctor shortage while enabling improved overall outcomes (meaning fewer strokes, heart attacks, and failed kidneys).

I have owned an at-home blood pressure monitor for many years. It enables me to achieve precise blood pressure control. I sometimes go days without having to take a blood pressure medication.

If I relied on doctors, I would not have known that the drug I had initially used was only providing me with about 12 hours of blood pressure control. If I relied only on doctors, I would later be taking a high-dose anti-hypertensive drug every day, even though on most days I don’t need it. (My blood pressure continues to drop as I lose weight...one of the benefits of calorie restricting.)

I have let dozens of people use my at-home blood pressure monitor. About half are hypertensive, yet only one person ever bothered making a doctor’s appointment and she went through a lot of hassles to get insurance to cover it.

If these hypertensive individuals were able to walk into a pharmacy and ask for a low-cost generic drug like losartan, I’m certain most of them would have done it.

The hassles of finding a doctor, setting up an appointment, waiting hours to see the doctor, dealing with one’s insurance (or paying out of pocket), dropping off the prescription at the pharmacy, then coming back to pick up the prescription causes too many people to ignore asymptomatic diseases like hypertension.

A one-month supply of losartan (sixty 50 mg tablets) if sold in a free market would cost less than $14 a month. This makes blood pressure control “affordable” to virtually everyone. Many pharmacies have blood pressure monitors for public use, so even if one cannot afford their own monitor, they could still achieve optimal blood pressure control.

The role of “individual responsibility” is significant as any drug can have side effects and there are certain people who should not take losartan such as pregnant women or women who may become pregnant. This information is instantly available on the Internet, so part of this kind of individual responsibility mandate is for people to spend a little time reading about any medication they decide to self-prescribe.

Naysayers to this free market approach overlook the impending shortage of doctors, the fact that most doctors aren’t adequately controlling their patients’ blood pressure and that hypertension remains a leading preventable cause of death.19 They also ignore the epidemic of hypertension-induced disability (despite universal screening in doctor’s offices) and the fact that America cannot afford the inflated costs of over-regulated sick care, despite federal mandates that virtually everyone now be “insured.”

My Family Member’s Urinary Tract Infection
Side view of pharmacist showing patient container of tablets

A family member of mine traveled to Southern California for a week. She called me the first night complaining of a urinary tract infection. I gave her two choices.

She could log on to Google to find what antibiotic was currently being recommended for urinary tract infections and drive down to Mexico to buy it, OR go to a walk-in clinic to obtain a prescription. She delayed doing either and suffered for several days before going to a walk-in clinic and of course facing all the delays in getting the prescription filled.

How efficient, I thought, if pharmacies could sell an over-the-counter package that supplied an effective antibiotic, a temporary pain reliever, and a standardized cranberry supplement to help prevent recurrence. Such a “Urinary Tract Infection Cure” package might include:

  1. Nitrofurantoin fourteen 100 mg tablets. One tablet a day to be taken twice a day for seven continuous days. This is one of the antibiotics of choice in curing urinary tract infections.20,21
  2. Phenazopyridine six 200 mg capsules. Take one capsule three times a day for two days. This drug relieves urinary tract pain, burning, irritation, and discomfort, as well as urgent and frequent urination caused by urinary tract infections.22
  3. CranMax® thirty 500 mg capsules. Take one capsule daily for at least 30 days.23,24

The cost for such a package would be less than $30, thus slashing this sick-care cost outlay, while mitigating the coming doctor shortage as urinary tract infections cause over eight million visits to physicians each year.25

The walk-in clinic visit alone for my family member cost over $150 and caused her to suffer days before finding the time to go. How much more humane and efficient if adults could buy a “Urinary Tract Infection Cure” package over-the-counter? 

Self-Treating Vascular Risk Factors

A comprehensive blood test can reveal a host of factors that can lead to a heart attack or stroke.

For instance, if fasting glucose is over 85 mg/dL, the rate of heart attack is 40% higher according to a large study of 22,000 people.26 In addition to the use of supplements (like green coffee extract) and lifestyle changes, people should be allowed to purchase glucose-lowering drugs like metformin and acarbose without tying up valuable physician time. Safety data is widely available and doses could be adjusted by empowered patients to achieve optimal glucose control.

Elevated LDL is one of many underlying causes of atherosclerosis. If LDL levels remained stubbornly high despite lifestyle changes and use of supplements, low-dose statins should be available on a non-prescription basis. I mention low-dose because doctors too often prescribe such a high dose of statin drugs that side effects manifest. We long ago described studies showing that far lower doses of statins can produce desired reductions in LDL without creating new health problems.27,28 Empowered patients managing their own LDL/cholesterol levels would eliminate many doctor visits that clog waiting rooms.

Low testosterone is a risk factor for cardiovascular disease in men.29-32 A physician help-line could be established whereby doctors review a person’s blood test results and prescribe testosterone over the phone, thereby enabling more aging men to enjoy youthful testosterone ranges. Follow up blood tests could guard against estrogen overload caused by the excess conversion of testosterone to estrogen, and rule out rare side effects (such as overproduction of red blood cells).

Government regulators today are particularly concerned about people using testosterone without in-person physician visits. The reality is that hurried doctors often don’t prescribe ideal individual testosterone doses, fail to protect against estrogen overload, and neglect long term follow up to ensure optimal free testosterone status. A help-line solely dedicated to providing superior hormone balance in aging men could free up frontline physicians that need to be available to treat patients with serious illnesses.

There is no question that physical examinations by doctors who have adequate time to spend with each patient have clear advantages. But with a looming doctor shortage, this is no longer possible, and aging individuals should be given options that will save them (and the sick-care system) substantial dollars.

Congress Partially Caused this Problem in 1997

With a growing, aging population, the demand for physicians will intensify over the coming years. The Association of American Medical Colleges estimates the United States faces a shortage of more than 90,000 physicians by 2020a number that will grow to more than 130,000 by 2025.35

Congress capped the number of federally supported residency training positions 15 years ago with the passage of the Balanced Budget Act of 1997.35

Increased medical school enrollment is part of the solution to addressing the doctor shortage.

Projected Supply and Demand, Physicians, 2008-2020

QUICK FACTS:35

  • Shortage of doctors by 2020:.........................................................90,000
  • Shortage of primary care physicians:...............................................45,000
  • Shortage of surgeons and specialists:...............................................46,000
  • Physicians likely to retire in a decade:............................................250,000
  • Americans entering the health care system in 2014:.....................32 million
  • Time from the start of med school until new doctors enter practice: 7 years

Nearly Half of Doctors Already Suffering Burn Out

A national survey of physicians finds the prevalence of burnout is already “alarming.

The report describes the looming physician shortage as millions of “newly insured” crowd waiting rooms, but the report stated that 45.8% of physicians already suffer a symptom of burnout.33

One doctor describes that being asked to see more patients, while not having enough time to devote to them makes one feel like “being on a hamster wheel.

Experts were surprised at the high rate of burnout in frontline physicians and stated that this will adversely affect patient outcomes and ultimately drive up costs, as sick people aren’t being efficiently cured.34

When I develop a medical problem, I don’t want my life to depend on a “burnt out” doctor. If adults are given the option of self-medicating for simple and common problems like elevated LDL, hypertension, and urinary tract infections, then the quality of care can increase as the patient load decreases.

A Trip to Mexico With My Son
Syringe on Mexico City map

Last year I wrote about a trip I took to Mexico where my 13-year old son was bitten by an insect. He developed a painful reaction that required immediate attention. Fortunately in Mexico, you don’t need a prescription to buy most drugs. I was able to walk into a pharmacy and purchase a tube of triamcinolone cream at virtually no cost. Within a few hours my son was cured.

In the United States, it is not so easy or affordable. For some ludicrous reason, the FDA mandates that we obtain a doctor’s prescription for topically-applied triamcinolone cream. If this insect bite had occurred in the US, I would have had to find an urgent care medical facility that was open, pay the doctor over $100, and then take the prescription to a pharmacy and wait for it to be filled. My son would have spent many additional hours in pain and I would have spent a lot more money and time.

If I could not locate an urgent care center, a hospital emergency room visit would be the only alternative. The cost to me and my insurance company would have been over $500.00 for an ER room visit as opposed to spending only a few dollars for a tube of triamcinolone cream at a Mexican pharmacy with no prescription.

The Mexican pharmacy, by the way, was overwhelmed with American tourists who were behaving like children in a candy store. The shelves were stocked with just about every popular American prescription drug, but no prescription was required. Prices for most drugs were a fraction of what they cost in the US.

The coming shortage of physicians mandates that most prescription drugs be available to empowered patients in the United States without the requirement of an in-person physician visit.

Public Needs to Act!

The public is fearful of change, even when circumstances dictate it and the overall result would be huge numbers of human lives spared.

The entrenched establishment dreads any variation that would reduce their profit machines and will not hesitate to disseminate false and misleading propaganda to protect their virtual monopoly.

The appropriate deregulation will eliminate the healthcare cost crisis, yet those who financially benefit from today’s broken system (like pharmaceutical companies) will violently oppose these rationale proposals.

Citizens must act and demand common sense change.

Penalties of Failing to Face Reality

This article only touches on alterations to healthcare regulation that would slash medical expenses, improve patient outcomes, and alleviate physician shortages.

The financial news publishes articles each day describing how sick-care costs are bankrupting governments, businesses, unions, and individuals. I ask when you read these distressing reports that you recall that Life Extension has battled the inefficient regulatory structure behind this cost crisis since the early 1980s.

We predicted with intrepid certainty that failure to tear-down suffocating regulatory barriers would lead to catastrophic economic problems while stagnating the scientific advancement.

The looming shortage of physicians will affect most everyone reading this article. It is just one symptom of a sick-care system plagued by regulatory inefficiency.

The best way to avoid becoming a victim is to take aggressive care of your precious health every single day, as I know most of you do already.

Comprehensive blood tests performed annually, and access to a blood pressure monitor, are two simple steps aging Americans can use to become “empowered patients,” thereby not being 100% reliant on hurried physicians.

For longer life,

For Longer Life 

William Faloon

References

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