Gaps in the Supply of Physicians, Advanced Practice Nurses, and Physicians Assistants

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<ul><li><p>13. Sherman R, Magee W. International missions: Cleft care. In:Losee JE, Kirschner RE, eds. Comprehensive Cleft Care. New</p><p>Dibo</p><p>GAdPh</p><p>AnRo</p><p>IHothethedicnu</p><p>andeicabaheem</p><p>1.</p><p>2.</p><p>3.</p><p>Just let us talk about the last matter, forgotten by many:thetobromeoneraco</p><p>wephspincrecbeme</p><p>wi</p><p>RE</p><p>1.</p><p>Di</p><p>R</p><p>RiPh</p><p>Drmabobocenfro1.0notheturan</p><p>sicworesmeun</p><p>574 Letters J Am Coll SurgYork: McGraw-Hill Medical; 2009:10291038.</p><p>sclosure Information: Drs Campbell and Lopez areth salaried staff surgeons at Operation Smile.</p><p>aps in the Supply of Physicians,vanced Practice Nurses, andysicians Assistants</p><p>tonio Vittorio Sterpetti, MD, FACS, FRCSme, Italy</p><p>read with much interest the article by Drs Sargen,oker, and Cooper,1 which appeared in the June issue ofJournal of the American College of Surgeons. Based onir careful analysis of the overall data available, they pre-t a significant shortage of physicians, advanced practicerses, and physician assistants in the near future.This shortage seems to depend on many factors, all wellalyzed. Their solution is to increase the number of resi-nt positions in the medical system. All sounds quite log-l. Then there is always the idea that the US will gonkrupt, sooner or later, because of the expenses of thealth system. Everything is based on statistics and math-atical equations.But let us look at things in another way:</p><p>The steady shortage of physicians in the US has at-tracted, in the past and today, the best minds and themost motivated people from all around the world, giv-ing new enthusiasm and new blood to the Americanhealth system.Tight control of the quality of the training system (notjust to increase the number of PGY positions) has al-lowed the formation of a first class generation of phy-sicians and advanced practice nurses, who have allowedthe American medical system to remain at the forefrontof medical sciences.Everybody looks at how much the US spends onmedical care. Nobody looks at 3 other importantaspects: the well being of the community (with itseconomic significance); the legitimate expectationsof a person who has worked all his life to have ade-quate medical care when needed, without discussinghow much it costs (with its economic significance,including the willingness to pay the exact amount oftaxes); and the economic rewards from being at theforefront of medicine.fact that the US is at the forefront of medicine (thanksthe money spent in the health system and education) hasught the American pharmaceutical and medical instru-nt industry to first place in the world, selling productsall 5 continents. Nobody takes this aspect into consid-tion. How much money in taxes is given back by thesempanies?Finally if we want to attract more people in medicine,should give physicians, advanced practice nurses, andysician assistants the respect they deserve for a lifeent in the service of people in need; this does notlude only the economic aspect but the right publicognition of their role in this society. In the past it hasen too easy, via every possible medium, to criticize thedical system.Let us be optimistic and do the right things; problemsll disappear by themselves.</p><p>FERENCE</p><p>Sargen M, Hooker RS, Cooper RA. Gaps in the supply of physi-cians, advanced practice nurses, and physicians assistants. J AmColl Surg 2011;212:991999.</p><p>sclosure Information: Nothing to disclose.</p><p>eply</p><p>chard A Cooper, MDiladelphia, PA</p><p>Sterpetti is correct that our conclusions are based onthematical equations. Health care follows the economyth up and down.We assumed slow, continued growth ofth the economy and health care spending. Recall that theterpiece of health care reform was to reduce growthm gross domestic product (GDP) 2.5% to GDP %. But also recall that the call was for less spending butt for fewer benefits, which means lower fees. Indeed, ifresult is that services grow more rapidly than expendi-es, our projections of the future demand for physiciansd other advanced clinicians may be too low.Dr Sterpettis observation that steady shortages of phy-ians in the past attracted the best minds from around therld is also correct.This happened because the number ofidency positions continually increased, even though USdical schools had ceased expanding in 1980, leavingfilled slots. But residency growth largely stopped in</p><p>Gaps in the Supply of Physicians, Advanced Practice Nurses, and Physicians AssistantsReference</p></li></ul>

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