With money particularly tight, getting through medical school is getting even harder than getting into medical school. The average MD graduate carries about $140,000 of student loan debt when he or she graduates. Malpractice rates are soaring, some into six figures, and since internships and residency add years to the day when a “good living” can be made, times are particularly tough for most doctors. Managed care and Medicare have put severe limits on doctor compensation. But this isn’t about why doctors should get paid more. It’s about the law of supply and demand.

Simply put, we do not have enough doctors to serve our needs. This comes at a time when we are considering increasing our medical capacity under some, yet-to-be-worked-out form of universal health care coverage. The shortage is particularly heavy at the primary care level, where most people begin their journey through the medical labyrinth.

The April 27^th NY Times: “Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. ‘We don’t have enough doctors in primary care or in any specialty,’ said Representative Shelley Berkley, Democrat of Nevada… Senator Orrin G. Hatch, Republican of Utah, said, ‘The work force shortage is reaching crisis proportions.’… Miriam Harmatz, a lawyer in Miami, said: ‘My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.’”

If we increase the number of graduates, supplementing medical education along the way, we still only produce an additional 5,000 doctors a year. So what are the alternatives? Aside from “making more doctors,” another alternative form of medical care – the nurse practitioner (licensed to dispense certain prescription and make basic diagnoses) seems to be where we are headed… at least at the initial screening stage and where an obvious emergency requiring more advanced medical training is required (such as provided in a hospital emergency room).

The strange thing is where such medical facilities – those with nurse practitioners dispensing prescriptions and giving shots – are showing up. According to the April 14^th CNNMoney.com: “Americans, frustrated by endless waits at the doctor's office, are sidestepping their family physician and taking their rashes, strep throat and pink eye to stores such as Wal-Mart and Walgreens instead.”

While those unable to afford health insurance at all might blink at the average $60 per consultation fee, for many this is a reasonable alternative and is often covered by insurance anyway. CNNMoney: “No. 1 drug store chain CVS already operates more than 500 MinuteClinics at its stores nationwide. Rival Walgreens plans to expand its health and wellness clinics to more than 800 in-store locations by the end of the year.” Serious cases are referred into the more traditional healthcare system.

Though nurses have less training time than full doctors and often can develop their skills overseas, we also face a severe shortage of nurses as well. The April 28^th Los Angeles Times: “The American Health Care Assn.'s most recent estimates from July 2008 show 116,000 open hospital nursing positions and more than 19,000 vacancies in long-term care settings… A March 2008 report by Dr. Peter Buerhaus of Vanderbilt University Medical Center and colleagues predicted that national nursing shortages could balloon to 500,000 by 2025. Predictions from the U.S. Department of Health and Human Services are more dire: It anticipates a shortage of 1 million nurses by 2020…A lack of faculty at nursing schools across the country is preventing many people from entering the profession, thereby exacerbating the shortage. Nearly 50,000 qualified applicants were turned away from professional nursing programs in 2008, according to the American Assn. of Colleges of Nursing.”

It comes down to importing qualified nurses or opening new programs to educate the next generations of nurses – re-prioritizing what young people study in the future. Whatever the solution, clearly widening the coverage of healthcare necessarily carries with it the expansion of those able to provide the required services. Nothing is going to alter our growing need for fully-trained doctors, but there are a few cushions along the way… if we can meet the demand of those seeking to be trained as nurses.

I’m Peter Dekom, and I approve this message.