TED Conversations

Martin Odber

This conversation is closed.

Can the shortage of doctors be solved using an adaptation of the third law of supply and demand?

The third law of supply and demand states "If demand remains unchanged and supply increases, a surplus occurs, leading to a lower equilibrium price."
( http://en.wikipedia.org/wiki/Supply_and_demand )

If we increased the rate of new doctors entering medicine (using mechanisms such as but not limited to; subsidizing doctors education, further compartmentalizing aspects of health care etc ) until we reached a surplus state then would waiting times and the cost of healthcare go down accordingly?


Showing single comment thread. View the full conversation.

  • luis c.

    • +1
    Sep 7 2013: Martin

    The mass production of doctors, with government subsidizing their education and training simply does not work. Cuba has been working on this experiment for 50 years with catastrophic results. Today, you can find hundreds of doctors driving taxis and waiting tables in many Cuban cities...
    • thumb
      Sep 7 2013: Interesting.
      How long are the wait times for doctors in Cuba?
      • Sep 7 2013: Wait time? Well, it depends on what segment of society one falls.

        1. If the individual is a senior member of the ruling party "the new elite", then these few have access to doctors, but more importantly, they have access to the exclusive hospitals and access to basic medical supplies and treatments.
        2. Foreigners with dollars seeking special treatments... the wait for this group is relatively short, if any.
        3. All others (overwhelming part of society). Here too there are two categories:

        a- Those who access to basic resources, primarily food. The wait for this group may be relatively short if the individual can offer a "gift" to the doctor. Example 10 pounds of meat, (typically pork since it is illegal to buy beef) rice, cheese, or some money. Yes.. service for food.
        The salary for a surgeon is approximately 600 (six hundred) pesos per month, that equates to US$24.00 (twenty four US dollars). The price for meat (if available) is approximately 25 cuban pesos per pound... do the math... The income of a taxi driver in Havana or Varadero is much higher than that of a doctor. Many doctors have to accept the "gift" just to survive.

        b- Those with no resources ( the great majority) it is hard to quantify the waiting time.

        For the majority of the Cuban people "wait time" is the least of their problems. The real challenge is procurement of basic medicines, medical supplies and treatment after they get to see the doctor.
        Bartering plays an important role in the procurement of basic medical supplies. Some lucky ones with family in the diaspora may receive basic supplies. However, there are strict government restrictions on quantity / weight of parcels allowed into the country.

        Patients in hospitals (those in the a and b group) are expected to take their own sheets and pillow to the hospital. Family members take a chair if they plan to stay the night with the patient.
        Unfortunately, this is reality for some 12 million people.

        "Wait time" is a relative term.
        • thumb
          Sep 8 2013: So.. in Cuba there are so many doctors that they are out driving cabs rather than practicing their profession, yet so few doctors practicing that wait times for the general populace are through the roof.

          Why does this seem out of context?

          All the funding goes into teaching people how to be doctors with no funding in the service infrastructure to allow them to provide service to the public?
      • Sep 8 2013: It seems out of context for one reason.

        Panned societies where the government plans all allocation / use of resources including human capital by training X number of doctors, X of teaches, X of scientists is wonderful in theory, but this model has failed time and time again. Among many things, the model ignores the natural forces of labor markets. More importantly the model fails to recognize the fact that individuals have different values, perspectives, character, goals and objectives. It assumes that all members of society have the same dreams and ethical imperatives.

        If we decide to fund the education of doctors to increase supply, who determines the equilibrium point? The government ?

        If we use tax dollars to fund / help those who study medicine, will we also help scientist, accountant, dentist, teachers ? Will the government decide which disciplines are important and which are not ? which disciplines get funded and those that will not ?
        • thumb
          Sep 8 2013: Whether we fund the educations of doctors or not " individuals have different values, perspectives, character, goals and objectives." is true. Funded or not funded does would not likely impact this I feel so I am not sure why we include it.

          The tipping point might become when wait times were down on average to say 2 hours maximum? That seem reasonable?

          AS for funding other professions, as a people we might look at that and ask where do our values lay on a situation by situation basis, however a persons health usually ranks at the top of concerns.
      • Sep 9 2013: Doctors in Cuba drive taxis because, if they do not get into the service of the elite, they can make as good a living driving taxis with less headache than a doctor has. This is the inevitable end result of any planned economy. Only the planners benefit in the long run.
    • W T 100+

      • 0
      Sep 7 2013: And many are working menial jobs when they immigrate to the US as well.
      • Sep 7 2013: Correct.

        Like all immigrant groups, Cuban doctors have to work in low paying jobs while they study to regain their MD license in the US. Since the early 60s Cuban doctors, and many other professionals have migrated to the U.S. in search for freedom and a better life. They worked in what you refer to as "menial jobs" to support their families. However, with perseverance and hard work hundreds have regained their accreditations and have built successful practices in the U.S... Yes, it takes hard work and sacrifice, but for the overwhelming majority of immigrants, the tradeoff is very worth it.
        • W T 100+

          • 0
          Sep 8 2013: Yes, I agree that the trade off for hard work is well worth it.

          The South Florida community has a lot of doctors from many Spanish speaking countries.
          Many doctors from Cuba have established their medical offices there.
          Others work for clinics, or hospitals.

          The most prosperous ones are the ones who speak English and are up-to-date with the latest medical advances. Many times their sons and daughters choose to pursue a medical career as well.

          Are you yourself Cuban?
      • Sep 8 2013: Yes, I am Cuban.

        To practice medicine in the U.S. all foreign doctors must pass board exams, the same as an MD who studies in the U.S. All exams are in english. If they practice medicine in the U.S., they must be well versed in the language and be up to date with medical advances.
        • W T 100+

          • 0
          Sep 8 2013: I am wondering, since there are so many Spanish speaking medical personnel from Cuba in S Florida, if all of them have passed board examination to practice medicine.

          I wonder, for example, if those that are working for clinics, are certified?
          Some listings (doctor's names) in the medical directory of various HMO's will say 'board certified'............others do not.

          Do you happen to know the answer to my question?

          Is board certification different from the exam foreign doctors have to take to practice medicine here?

          I do appreciate your replies to me.......thank you.
      • Sep 8 2013: i am not in the medical field and i am not familiar with the board process / requirements.
        Many who are not board certified may work as nurses or technicians in the medical field.

        • Sep 12 2013: In the United States, there are several levels of certification for doctors. To call oneself an MD or DO, one must take a four year post graduate medical school course, and pass "the Boards", which are a three part test, each test taken two years apart. One must then take at least one year of internship. At that point, one may get a medical license, but the doctor is NOT board certified. To become "board certified", one must take an additional residency of three to up to ten years, then take a certification test. Each specialty sets its own requirements for the certification. One may only say they are "board certified" in that specialty once they have met the requirements set down by that specialty. For instance, any doctor may call himself a cardiologist, so long as he has a medical license. He may NOT call himself board certified unless he has met the requirements of the American College of Cardiologists. A foreign trained physician may become a US physician simply by passing the USMLE test, and satisfying the individual state's requirements for internship. However, "board certification" has the exact same requirements for a foreign trained or US trained physician.

          BTW, I am a US trained radiologist.

Showing single comment thread. View the full conversation.