Maybe. The unpleasant truth is that we don't have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who'll begin to gain coverage under ObamaCare starting in 2014.
Changing demographics and perverse reimbursements are the main culprits. But ObamaCare didn't do much to address the underlying problems. Estimates vary, but the Association of American Medical Colleges predicts the U.S. will be short 130,000 doctors across all specialties by 2025. In fact, about one-third of all doctors plan to retire in the next decade.
Today, nearly 20 percent of Americans lack adequate access to primary care because there aren't enough physicians. About 30 percent of doctors won't accept new Medicaid patients. About one-third of ObamaCare's insurance expansion will come through expanding Medicaid.
ObamaCare relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. After adjusting for population growth, aging and demand for care created by the newly insured, we estimate that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under ObamaCare.
Medicare grossly underpays primary care doctors compared with specialists and pays nurse practitioners 85 percent of what it pays doctors for the same services. And medical students are leaving school with crushing debt.
ObamaCare's focus on expanding health insurance left many of our biggest access-to-care challenges untouched. Get ready for Health Care Reform 2.0, starting next year, when many of America's newly insured realize that they have to get in line to see a doctor when they need one.
| Commentary |
CMDA CEO David Stevens, MD, MA (Ethics):"Why go to
school for seven or eight years to become a primary physician when you can make
85 percent of a physicians salary as a nurse practitioner by adding just a
couple more years of schooling to your undergraduate degree? You also will come
out with a lot less debt. The median debt for a public medical school in 2012
was $160,000 and for a private $190,000.1 It is
no surprise that only 25 percent of allopathic school graduates are going into
primary care, but even that statistic may be misleading since 75 percent of
students matching to internal medicine programs go into specialties.2 That is one of the reasons that osteopathic schools are
prospering. Their number has grown from 19 campuses in 2000 to 37 in
2013.3 More than half their graduates go into
primary care.4 Unfortunately, their debt load
average on graduation is higher than allopathic schools by almost 25
percent."Economic disincentives have seriously damaged primary care and, if surveys are right, it will be worsened by the large number of physicians planning to retire early due to their concerns about Obamacare.5 Ultimately, patients will pay the price with decreased accessibility and poorer health.
"The ranks of mid-level professionals are increasing dramatically to fill in the gaps, but we should be concerned that a significant drop in primary care physicians will leave a dangerous knowledge and experience void between what mid-levels can provide and what specialists should handle.
"This cloud does have a silver lining! With the need for more physicians, it has opened the door for two Christian osteopathic schools to be up and running by this fall and two more are in the planning stages. I’ve also noted that there seems to be a higher percentage of Christian students on secular osteopathic campuses than allopathic ones and they seem to maintain a more balanced life."
1.https://www.aamc.org/download/152968/data
2.http://sphhs.gwu.edu/abouttheschool/news/?d=12544
3.http://www.aacom.org/about/colleges/Pages/default.aspx
4.http://www.princetonreview.com/medical/osteopathic-medicine.aspx
5.NewsMax “Sixty percent of the doctors responding to the Deloitte Center for Health Solutions survey are likely to will retire sooner than planned in the next one to three years, irrespective of age, gender or medical specialty.”
It appears we are returning to the pre Flexner era where involvement in healthcare is rather eclectic on the public's side. It is still, however, most regulated over the physicians the Flexner report targeted in 1910. The spinoff professions look to be less regulated with less penalty for performance than the physician targets. I am disappointed in the article referenced above regarding the "Nurse Practitioner 85%" apparently written by nurses. Outcomes for NP's have not yet been tested because physician oversight is so readily available and actually mandated in all cases that do not appear to be going as planned. This is a very complex transition. If patients are just being judged to be sick or not sick and routed to the right specialist, I am sure NP and PA's are adequate to provide this level of referral of care. We see this transition in Emergency Departments now. Nurses are adequately trained to be able to assess and call or refer for care. Nurses are not trained well in medical diagnosis, though once diagnosis is established, they do well in manipulating medications within a class for the patient. The America College of Physician white papers indicate that nurse ordering of drugs and devices is easily influenced by marketing and that cost of care is increased with more test ordering, though in an environment lacking tort reform defensive ordering of tests may produce some equity between the nurses and physicians. We are just one generation removed from the generalist providing all the care that was available to most patients. In the present time of expansion of specialization, specialist controlled practice privileges granted by hospital credentials committees and limitation of generalist practice, we may be approaching an era where two tiered care will prevail. Entrance into the medical system may be through a non physician and specialty care assumed by physician specialists for each of multiple organ dysfunctions while wellness is managed by the evidence based check off criteria of cook booked quality measures. I think we are closer to this than returning to the "man (or woman) for all seasons" generalist of the last generation of physicians. There are vast differences in training and experience provided by that training and monitoring of the physicians of the past and present day advanced practice nurses and PA's as Dr Stevens has pointed out. Unfortunately, it appears that state legislatures will have the final decision based on who has their favor in this debate over this huge uncontrolled experiment.
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