Today’s front page story in USA Today is about a shortage of surgeons at U.S. hospitals, with a focus on rural areas; the shortage threatens the health of 54 million rural Americans, reports Robert Davis. Part of the problem is that medical schools held enrollment steady for too long, rather than increasing it to account for the fact that so many doctors will be retiring at the same time that aging Boomers are needing more care. But changes in U.S. healthcare have also played a role.

Med school loans spur a lot of medical students to choose a high-paying field and then go where the money is:

“[F]ewer and fewer are going into family medicine and primary care,” says James King, president of the American Academy of Family Physicians. And “many are not willing to go” to rural areas.

After an industry-wide review of allegations that surgeons were charging too much, Medicare lowered the amounts that the U.S. government pays doctors during the 1990s. For some common procedures, general surgeons now get about half the money they received 20 years ago, Fischer says.

“Are the best and the brightest going into medicine like they once did? The answer is no,” [Beth Israel Deaconess Medical Center Chairman of Surgery Josef] Fischer says. “They are becoming investment bankers, attorneys and captains of industry because the American way — how prestigious things are — depends on money.” …

King says some of his physician friends are telling their children to avoid medical school.

“They tell their kids not to go because of all of the hassles,” says the family physician from Selmer, Tenn. “They say it’s not worth the headaches anymore.”

By “headaches,” Dr. King might be referring primarily to long hours and time on call, but I doubt it. Having a lot of family members in medicine, I hear a lot about the headaches of healthcare practice, and they mostly involve insurance and reimbursement issues. Time and mental energy that medical professionals want (and ought) to use for interacting with patients or keeping up on medical literature goes instead to slogging through an ever-changing landscape of the covered procedures, documentation, and reimbursement practices of payers. Doctors in private practice have to hire staff solely to deal with the paperwork, and then they have to see more patients in order to meet their expenses; for primary care doctors whose reimbursement rates are low, this means scheduling several patients each hour and spending just a few minutes with each one. Does this sound like an appealing job?

Driving away good potential physicians: one more hard-to-measure cost of our current healthcare mess.