Medical professionals are overwhelmingly concentrated in metropolitan areas. What are the implications of their locational preferences? The consequences may be especially dire for the growing population of non-urban elderly, the poor, minorities, and country folk.
And if geographic maldistribution is not troubling enough, we shall see that the operative word when it comes to nearly every type of medical professional is "shortages." Healthcare workers are leaving the profession, frustrated by stagnant salaries and loss of autonomy. Smart, hard-working young people who might replace them fail to see the point of sacrificing years of their lives for little return. The finger of blame is pointed at managed care — our rapidly expanding system of health insurance, which controls costs by placing limits on physicians' fees and restricting a patient's choice of physicians. We shall see that there is a pervasive dissatisfaction among healthcare workers with the managed care system. Doctors say it is robbing them of their dignity. Nurses say cost-saving measures required by managed care are wearing them out and endangering the safety of their patients.
On the bright side, the media are full of stories these days about the wonders that rapid advances in medical knowledge have in store for us. Geographic maldistribution may become moot if doctors are able to perform surgery using robots on patients many miles away. Writing for Futurist in 2001, Cetron and Davies predicted that medical advances will soon have us at the point where "the need for hospital and hospice care could plummet. Except where surgery is required, most patients will be treated at home by nurse practitioners, physician's assistants, technicians, and other non-physician providers."1The questions we are left with: Can these medical wonders become commonplace if there are not enough healthcare workers to oversee them and no one is willing to pay for them?
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