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In Near Future, More Doctors May Make Fewer Dollars

May 17, 1985|ALLAN PARACHINI | Times Staff Writer

Though the public may not realize it, doctors are being caught increasingly in a squeeze that may, by 1990 or the turn of the century, radically alter the way medicine is practiced and the manner in which physicians are accustomed to living.

Economists and social science experts prominent in the arcane field of health care public policy have already made quite a lucrative sideline of trying to fathom the physician crystal ball, a process that has had mixed results and yielded often contradictory predictions.

Among the most prominent of these experts is Columbia University economist Eli Ginzberg, who, in a medical journal editorial to be published today, makes nine specific predictions of what the future holds for doctors and their patients. Ginzberg has a history of accurately forecasting trends in the supply of physicians and its implications for health care consumers.

As early as 1965, Ginzberg contravened what was then the national perception of an emergency posed by a shortage of physicians, predicting that policy steps being taken then would produce a harmful glut of doctors. Many prominent study commissions and experts inquiring into the situation in the last five years have conceded that the glut prediction has come true.

Wrote Book on Subject

And while Ginzberg--who published a book aimed at a professional audience on the same general subject last year--concedes that his accuracy this time may not be total, he says he is convinced that "some of them, although surely not all, will turn out to be correct." Among Ginzberg's predictions are these:

--Though a government commission recommended in 1980 that drastic steps be taken to stem the oversupply of doctors--which, it is often argued, drives up the cost of health care without adding to its quality--the number of doctors in the United States will continue to go up in the foreseeable future. That will result, for "certain," in individual physician incomes dropping, "probably appreciably." The irony in this is that the 1980 warnings, if they had been heeded, could have forestalled much of the disruption. But at all levels of government, and within the profession, asserted Ginzberg--who was not a member of the commission--progress has been "excruciatingly slow."

Fewer Hospital Admissions

--The United States has probably reached the absolute limit in terms of use of hospitalizations, as questionable admissions are eliminated and procedures done on an outpatient basis are substituted for those that now require an overnight stay. With fewer people admitted, the hospital system will continue to follow a quickening trend toward merger of many facilities and growing influence of entrepreneurial, for-profit concerns whose motives have been widely questioned. Many hospitals will be turned into nursing homes. Many others will be driven out of business by a lack of patients.

--Doctors' appointment books will become ever more scantily booked. The number of visits to doctors per capita will continue to decline. At the same time, with young physicians emerging from medical school saddled with ever-increasing debts in the form of loans, they will face staggering costs when they attempt to get into practice. The result will be that young doctors will be drawn increasingly into health maintenance organizations and other group practice situations, bringing about a trend toward disappearance of the traditional doctor's office.

--With more and more competition for an ever-more constrained number of dollars spent on health care services, doctors will increasingly find themselves competing with hospitals--institutions with which physicians have traditionally been the closest of allies. In such business enterprises as outpatient surgery, doctors and hospitals will be locked in competition for the same patients, as doctors' offices and hospitals, increasingly, offer the same services. Competition will occur in ways not yet even anticipated.

Ginzberg's predictions are being published in the Journal of the American Medical Assn., where they will almost certainly provoke still more debate among doctors in a controversy that was already raging.

Physicians Shaken

Ginzberg said he wrote the editorial, for the AMA's most widely circulated journal, because he was struck by the extent to which both young and older physicians seem shaken by what they perceive as major changes in their profession, occurring right before their eyes, largely outside their control.

In a telephone interview from Puerto Rico, where he was doing some consulting work, Ginzberg agreed that the net result of the drastic change now taking place will quite likely be destruction of the traditional image of the American doctor. Though some experts have argued that the image has been largely a myth, anyway, the physician has been seen as a rugged individualist, waging a solo war against disease and discomfort, enjoying status as almost a priestlike figure.

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