On its front page, the New York Times (7/29, Lowrey, Pear, Subscription Publication) reports that expanded health insurance and Medicaid will not translate to all the healthcare needed in the US, in part because the country dramatically lacks the number of doctors it needs to deliver that care.
The Times uses Riverside, California, as a base for explaining the dilemma, pointing out that “the Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025. … Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.” The Times examines some underlying causes and says experts suggest changes in healthcare delivery, such as “building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams.”
“Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.”
Blogfinger Medical Commentary: By Paul Goldfinger, MD, FACC
In our last AMA report, (BF link ) we discussed the fact that many doctors are fearful of the future and are leaving the private practice of medicine for hospital jobs or just retiring early. There are a variety of reasons why doctors are feeling discouraged, but one fact is clear: There is a doctor shortage, and it will get worse. With the addition of millions of newly insured patients, it will become more difficult for everyone to get access to physicians’ services. It will take longer to get appointments, and necessary testing and treatments may be delayed. Quality of care will be compromised for everyone because of this.
The physician shortage will be aggravated by new regulations that tell a doctor how to practice, such as the new guidelines for mammograms, ECG’s and PSA testing. Dependency on primary care doctors to be gatekeepers who will oversee care for each patient doesn’t work very well in real time. I suspect that access to specialists will be regulated, and using nurses as some sort of “barefoot doctors” is largely a fantasy because it is risky and there is a shortage of nurses.
The ideas of easy access via walk-in clinics, teams of doctors providing coordinated care, and elimination of fee for service are potentially helpful, but those ideas are a long way off.
The new health plan will subtract $500 billion from Medicare, and much of that will be by reducing payments to providers, including physicians. This will drive some more docs out of practice for financial reasons—they will be unable to stay in the black when running a private practice. Others will refuse to see insured patients if the fees are too low. Elimination of fraud, waste and abuse looks good on paper, but implementing that will be a nightmare.
The doctor shortage is a fact, and it is only one of many changing pieces of the healthcare puzzle which will impact the quality of care which we will receive in the future .
On Blogfinger we have been focusing on quality care while avoiding politics; however, you can’t avoid the fact that politics will be at the center of the search for solutions. It will be a very bumpy ride.