Pesky kids’ doctors keep practicing in the wrong places

C. Scott Litch Contributor
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The Associated Press recently reported on an analysis in the journal Pediatrics indicating that pediatricians and family physicians are located in the wrong places. We can certainly all agree that all children need doctors. But how to get there is the rub.

The number of pediatricians increased by 51 percent from 1996 to 2006. The supply of family doctors grew by 35 percent over the same period. The population of children grew by only 9 percent during those years. So there are plenty of doctors for children, right? Oh, how wrong you would be! Turns out the doctors are simply selfish human beings who practice in the wrong areas, refusing to listen to government planners and academics who could tell them where the right areas are located.

The study reports that some wealthy areas are oversaturated with pediatricians and family doctors, while other parts of the nation have few or none. Nearly 1 million children live in areas with no local children’s doctor; however, before you panic, keep in mind that this “crisis” affects just 1 million out of the roughly 75 million children in the country, or only 1.3 percent.

To address this 1.3 percent catastrophe, the study suggests that the government should relocate doctors so that every child can have a pediatrician or family physician nearby. I’m not sure exactly how this would be accomplished. Perhaps with large moving vans, reinforced by local police. Perhaps a government agency would approve (or reject) your practice location choice. You think I jest, yet moving doctors is what some recommend:

There should be more focus on evening out the distribution than on increasing the overall supply of doctors for children”, said lead author Dr. Scott Shipman of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

Personally, I worry that our nation’s physicians are already well on the road to serfdom, considering the many government controls over how they practice medicine. Now, another academic social engineer is suggesting that the government should intrude on their personal choices of where to locate their practices.

Indeed, some might say that since the federal government does spend a lot of money to help train physicians, it should be able to tell them where to practice. But if federal money carries this level of control, then logically any college graduate who receives a dime of federal student financial aid should check with the appropriate “czar” before making any decision about where to work.

The social engineers are frustrated about doctors locating in places where there is already an “over-supply” of doctors. It is interesting that they use this terminology, because if an area actually was in over-supply, surely the doctors would not be able to make a living and would be forced to move elsewhere. Obviously, the doctors can make a living in such areas, and by god most insist on doing the logical thing by moving to the best available areas. By best, I mean those with good housing, good schools, low crime, cultural amenities (museums, theaters, etc), clean parks, hiking/biking/running trails, convenient travel access, etc. Why do these pesky doctors do such logical things, rather than acting contrary to human nature? Saddled with high graduating debt from medical school and residency training, why do they think they can make their own decisions about where to practice? Damn them for wanting to practice in more affluent areas! Why don’t they want to practice in the middle of nowhere in some god-forsaken hellhole? Why don’t they want to go back to the farm and get up at 4:00 am to milk cows?

But we are instead faced with this amazing finding: most regions with many children’s doctors are wealthy, and most regions with fewer such doctors are poor and rural. The key economic reason for this is that there are more uninsured and Medicaid patients in poor, rural areas, and the chronically low payments from Medicaid are a constant disincentive for doctors to locate in these areas. However, rather than fix the Medicaid program and perhaps send a few buses or medical vans out to the hinterlands to allow the children to see real doctors, some suggest we spend much more of taxpayers’ money on schemes to get these darned doctors to places deemed acceptable by the social engineers. Pesky doctors, welcome to the Obamacare zone!

C. Scott Litch is the chief operating officer and general counsel for a non-profit association. Scott is a licensed attorney, Certified Association Executive, and also holds a masters degree in public policy. He is the author of The Principled Conservative in 21st Century America, released in the fall of 2010 just prior to the GOP mid-term election tsunami.