Thursday, August 9, 2012

Are we running out of doctors?

Excerpt from "Is America running out of doctors?," The Week. July 31, 2012--The primary objective of President Obama's overhaul of the healthcare system is to extend coverage to the tens of millions of Americans currently without insurance. "But coverage will not necessarily translate into care," because there may not be enough doctors to treat everyone, say Annie Lowrey and Robert Pear at The New York Times. The U.S. is already facing a severe shortage of doctors, particularly in rural areas of the country, and the problem is only expected to get worse as more Americans gain insurance.

The pool of new doctors hasn't kept pace with several factors boosting the number of people seeking care: population growth, the Obamacare expansion and an aging Baby Boomer generation that requires additional medical attention. Furthermore, the U.S. is facing an acute shortage of primary care physicians, leaving many patients without access to general practitioners, pediatricians, family doctors and other providers of basic medical care. "A shortage of primary care and other physicians could mean more-limited access to healthcare and longer wait times for patients," say Suzanne Sataline and Shirley S. Wang at The Wall Street Journal. The shortage will likely most affect those on Medicaid, the insurance program for the poor and disabled, since Medicaid's rolls are expected to expand significantly under Obamacare. The shortfall of doctors could reach 100,000 by 2025.

Obamacare contains modest provisions increasing Medicaid primary care payments and incentives for medical students to become primary care physicians. The number of primary care residencies climbed 20 percent between 2009 and 2011, but it's still not enough. Communities have been encouraged to create more walk-in clinics, and to allow more nurses to provide primary care. In addition, the U.S. could alter its immigration policies to attract doctors from overseas, "which should be very easy to do since doctors in the U.S. earn on average about twice as much as their comparably trained counterparts in Western Europe and Canada," says Dean Baker at Business Insider. Click here to read full story.

David Stevens, MD, MA (Ethics)CMDA CEO David Stevens, MD, MA (Ethics): "Though the facts in the article are not completely correct, the problem is obvious. There may be one million licensed physicians in the U.S., but according to a 2010 report from the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality, only '624,434 physicians in the United States…spend the majority of their time in direct patient care.' Less than one-third of these physicians are in primary care, yet they saw 51.3 percent of the office visits that year.

"A number of contributing factors to the primary care shortage are not mentioned. The high cost of medical training and growing graduate debt loads puts increasing pressure on students to select more lucrative specialties. More and more physicians in primary care refuse to take Medicaid and Medicare patients due to meager reimbursements, further exacerbating the problem of too many patients and too few doctors. Faith-based physicians are more likely to work in underserved rural and urban environments, but attacks on healthcare right of conscience could severely diminish their numbers.

"However, we do see some positive signs. The number of osteopathic schools doubled from 17 to 34 since 1997 and the number of graduates is increasing by more than 7 percent each year. While more than 50 percent of osteopathic graduates go into primary care, less than 8 percent of allopathic medical students went into family medicine in 2011. The number of allopathic graduates entering primary care decreased by 51 percent between 1997 and 2010. That showed some modest improvement in 2011. There were 100 more family medicine residency positions in 2011 than in 2010 and a net increase of 176 U.S. graduates took these positions. Unfortunately, that growth hardly begins to meet projected needs.

"What should be done? Since 95 percent of family medicine graduates stay in their specialty compared to only 21 percent of general internal medicine residents, we need to focus on increasing the number of family practitioners. It is going to take money to do it because money created the problem. Reimbursement rates may need to significantly increase if the patient-centered medical home is going to become a reality. The mean salary for a family practice doctor has increased modestly to $175,596, great disparities still exist between doctors involved in primary care and other specialties.

"A better solution would be to create a loan forgiveness program that could be even more successful in increasing the number of physicians in primary care. Federal Qualified Clinics (FQC) already have a government program that can forgive up to $30,000 dollars a year in debt for physicians who practice in their clinics. An increasing number of young doctors planning to go into medical missions are practicing at FQCs to pay off their debts before serving. Why not do the same for U.S. graduates staying in primary care? It would be a great incentive and could level the playing field with other specialties.

"Continuing to exacerbate the brain drain from less developed countries by recruiting their physicians is not the answer. More physicians, nurse practitioners and physician assistants need to be trained to meet the looming need. The time to start is now, especially since it will take seven years before physicians enter practice even after new schools are created or medical school classes expanded. I’m excited that some of the projected need will be met from the five Christian osteopathic schools (William Carey – Mississippi, Campbell University – North Carolina, Liberty University – North Carolina, King College – Tennessee and Indiana Wesleyan – Kansas) that have opened or are being planned. Each of these schools is focusing on creating primary care physicians. Together, these five schools will turn out 750 graduates per year. With every problem, there is an opportunity. This crisis is already spawning a greater Christian influence in medicine."

Affordable Care Act Impact on Doctors and Patients (PDF)
CDD STAT - Stewart Harris Professor of Constitutional Law at Appalachian School of Law
CDD STAT - Richard Doerflinger Associate Director of Pro-Life Activities at the United States Conference of Catholic Bishops

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