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Becker’s Healthcare Podcast
Scott Becker - 22 Things to Know About the Healthcare System 9-15-25
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This is Scott Becker with the Becker Healthcare Podcast. Today's discussion is 22 Things to Know about the Healthcare System. Bear with me as we go through this list. We hope you enjoy it. Please feel free to text Scott Becker, publisher, founder of Becker's Healthcare, with any comments or questions you have about this podcast. Again, My text is 773-766-5322. Thank you. First, we have a little more than 900,000 practicing physicians in the country that are directly providing patient care. That's against the total number of about 1.15 million or 1.2 million doctors in total, but about 900,000 directly providing patient care. We produce yearly about 25,000 doctors and about 185,000 nurses enter the workforce as well. So to put that in perspective, 25,000 doctors a year join the workplace. About 10,000 doctors a year retire. The nurse numbers are pretty similar. About 185join. Substantial percentage leave each year. So we're staying a little bit above even on the nurses and even on the doctors, even though we're staying above even in total numbers. In terms of total doctor hours, we're probably falling behind, and we're clearly falling behind compared to the population. Third, a substantial percentage of doctors go part time by the age of 40. That number is reported all over the place, but it's a big number. A significant percentage also give up clinical medicine entirely by 40. This number of doctors going part time also amplifies the challenges of the ratio of doctor hours to our population of 345 million people. Fourth, there's areas of the country where it's nearly impossible to find a doctor or a specialist. In many areas, you can't find primary care without going concierge, or you can wait a year for an appointment. I remember recently I tried to reschedule my appointment. The next appointment they had out was about 10 months away in terms of a primary annual physical appointment. In other areas, the ratio of specialist population, just awful. A lot of this comes from just reading and talking to physicians. But also on our podcast, we interview physicians a lot. There's one place in Minnesota where we recently interviewed a dermatologist. There's one dermatologist for a population of about 500,000 people. Similar neurologists, you've got the same challenges in Texas, an area where there's one neurologist for 500,000 people. That's at a time with rising dementia, Alzheimer's and other kinds of brain illnesses. Similar tremendous challenges on the behavioral health side. Fifth, nurse development is accelerated. Last several years Dr. Velman stalled. Other countries produce doctors in three to four years quicker than we do. We're doing a horrible job here of expediting medical education. A lot of it was developed prior to the Internet. Again, those are our first five points to move on to the next five points. 60% of health systems in the country currently have some margin. 40% do not. Seventh, at Beckers Healthcare we recently reported on 73 health systems cutting jobs. That's just a sampling of the systems cutting jobs because they're concerned about margins. And we talked about another 22 or so hospital closures this year so far. Eighth, more than half of Medicare is now through Medicare Advantage. Again, tremendous political power amongst those providing Medicare Advantage insurance plans and they tend to beat up on providers. Providers tend to increasingly hate the Medicare Advantage program. Ninth, the four largest payers in our country are massive. These include United, cvs, Cigna and Elevance of interest. United is one of the top five largest companies in America. These four are also for the largest public companies by revenues in the United States. So these are for the largest companies by revenues in the country and by by revenues. 10th. The improvement in solving chronic diseases in our country is starting to stall for years made lots of inroads. Cancer and heart disease remain the two biggest causes of death in our country. Twelfth, Medicaid coverage is going to see some cuts over the next several years. This will also negatively impact providers. Lots of discussion around that. 13. The five largest tax systems are Kaiser Permanente, Common Spirit Advocate, Providence and upmc. There are several other systems that are right there as well. But again the size of these systems pales in comparison to the size of the payers which are massive. 14th. Every week we see reports of closures of units and of facilities. Never a good thing. 15 is the ratio of doctors to population has gotten worse. What has gotten a lot worse is the administrative costs in healthcare. These are enormous. Even at the big payers they're trying to run medical loss ratios to 85% or so. This means there's a huge amount of money that's going into administrative versus clinical medicine. 16. At the end of the day we need more brilliant and energetic and curious and compassionate doctors and problem solving doctor leaders at all levels. And just the need for this is acute in getting more and more so and especially as we continue with doctors, both clinical medicine and administrative leadership. Seventeenth, AI and technology, preventive care all help. But we also need more doctors and nurses too. We need the best and brightest to lead the way. Too many of the best and brightest or lost in finance, technology and other places. Today, technology and pharma are very important, but they're not a panacea. We often think about 2x solutions which leverage physicians versus 10x solutions which really replace physicians. We're well on our way to lots of 2x solutions, but not enough to make up for the great loss of physicians and nurses and the shortages that we have. 18th changing the payment system, in my view, is not the answer. Whether it's value based care or fee for service, we have different problems. Under value based care, people under deliver care, under fee for service, you get a percentage that over deliver care. Either way, it's not going to be the solution. The real solution is reducing administrative cost as part of the answer, improve technology and improving the labor force around doctors and physicians and nurses. 19th doctors, hospitals, nurses remain the backbone of our system and our safety net. So I can't understate or overstate the importance of closing the gap in the numbers of doctors and nurses that we need to provide care to go with technology in pharmaceuticals. 20th childhood vaccines, research, GLP1s and constant improvements are really, really important. We're a huge fan. We need more and more of them. Not even a question 21 the affordability of health care is getting worse and worse. The average increases yearly outpace inflation. Over the last seven years it's been a 7% increase per year. The total average cost for an employer sponsored plan has risen to more than 25,000 per year. This includes premiums plus deductibles. The deductibles, the employee issue, those is around 6 to 7,000. The insurance part of it is 18,000. I know at my law firm we're paying even a higher amount than that. I just don't see an ended site to that raise in healthcare cost. In some ways the payers with the Medicare system, with the Medicare Advantage, with everything else, have just added another tax on top of the system without necessarily any real help in providing better quality care or better rationed care. It just seems like it's become a debacle. Finally. 20 second, to bend the cost curve, we're probably going to need to simplify greatly the administrative and payment system and push a lot of care to PAs and tax. We have a discussion in a different podcast. If I were king for the day, here's what we do. And as a side, maybe I didn't hit this point right enough. We do believe that childhood vaccines are critically important in this concept of this war against vaccines is overstated, misstated and just a problem a different point. Thank you for listening to the Beckers healthcare podcast. Thank you very, very.