OT: Reform's Great, But We Need More Doctors

[Guest guest]

Opinion: Reform's Great, But We Need More Doctors

 

Kevin Pho, M.D.

Special to AOL News

 

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(March 30) -- Health reform has passed, and the United States is poised to

join the rest of the industrialized world in providing most of its citizens

with affordable health coverage.

 

But having health insurance doesn't necessarily mean it will be easy to find

a doctor. Even before reform, reports projected a

shortfall<http://www.aolnews.com/health/article/health-care-overall-likely-to-st\

rain-doctor-shortage/19417616>of

40,000 primary care physicians over the next decade. Thirty-two

million

newly insured Americans, plus the millions of baby boomers entering Medicare

age, will only make this shortfall worse.

 

As a primary care doctor in New Hampshire, I have had the opportunity to

observe the effects of health reform in neighboring Massachusetts, which

enacted a similar approach to universal coverage in 2006.

 

To its credit, Massachusetts covers 97 percent of its residents, the highest

in the country. But its wholly unprepared primary care system was unable to

handle the 500,000 newly insured patients looking for a regular doctor.

According to the Massachusetts Medical Society, a primary care internist had

an average wait time of 50 days for new patients, with almost half refusing

to

accept<http://www.massmed.org/AM/Template.cfm?Section=Home6 & CONTENTID=23121 & TEMP\

LATE=/CM/HTMLDisplay.cfm>to

new patients.

 

When Amherst, Mass., family physician Kate Atkinson decided to accept newly

insured patients, she was forced to close her doors six weeks later. She

told the Boston

Globe<http://www.boston.com/news/health/articles/2008/09/22/across_mass_wait_to_\

see_doctors_grows/?page=full>that

" there were so many people waiting to get in, it was like opening the

floodgates, " saying that her office is getting " 10 calls a day from patients

crying and begging. "

 

And this is a state that already has the highest number of

doctors<http://bhpr.hrsa.gov/healthworkforce/reports/statesummaries/massachusett\

s.htm>per

capita nationwide. It's frightening to imagine how other parts of the

country, most of which have significantly fewer primary care doctors, can

handle the influx of patients if Massachusetts can't.

 

Any hope to bolster the primary care work force, unfortunately, is not on

the horizon.

 

With medical students graduating with an average educational debt exceeding

$150,000<http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sect\

ions/medical-student-section/advocacy-policy/medical-student-debt.shtml>,

new doctors overwhelmingly choose to become specialists, which offer

salaries several times more than those of primary care doctors. In the 2010

residency match, fewer than half of family practice residency slots were

filled by American medical graduates, compared with more than 95 percent in

fields like <http://www.nrmp.org/data/advancedatatables2010.pdf> radiology,

anesthesiology and orthopedic surgery.

 

Furthermore, nurse practitioners and physician assistants, who can help

alleviate the shortage, are also enticed by the lucrative allure of

specialty care. As Newsweek <http://www.newsweek.com/id/234218/page/2>recently

reported, " almost half of current nurse practitioners and physician

assistants work in specialty practices, where the money is. "

 

Health reform does try to help primary care, through modest improvements to

Medicare and Medicaid primary care clinician payments, better funding of

loan repayment programs and pilot programs for new primary care models. But

these incremental solutions fail to appreciate the enormity of the problem.

 

Nor do they address the phenomenon of physician burnout currently plaguing

the field. A survey published last year in the Annals of Internal

Medicine<http://www.annals.org/content/151/1/28.abstract>found that

nearly half of primary care doctors reported practicing in a work

environment " strongly associated with low physician satisfaction, high

stress ... and [an] intent to leave. " Indeed, almost one-third said they

were likely to leave their practice within two years.

 

At a time when primary care physicians are needed most, health reform does

little to relieve these frustrated doctors of the unreasonable time

pressures and onerous bureaucratic requirements that worsen their practice

conditions and obstruct their patient relationships.

 

Providing affordable health care to an additional 32 million Americans is

certainly worth celebrating. But whether our beleaguered primary care system

can meet the challenges that lie ahead will be critical in determining

health reform's success or failure.

*

Kevin Pho, a primary care physician in Nashua, N.H., blogs at

**KevinMD.com*<http://www.kevinmd.com/blog/>

* and is on Twitter **@KevinMD* <http://twitter.com/KevinMD>*.*

 

*

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