Monday, April 27, 2009

Physicicn shortages, doctor shortages - No Doctors, No Reform

WASHINGTON, — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

Robert Pear, Shortage of Doctors an Obstacle to Health Reform, New York Times, April 26, 2009

Suddenly, it seems, the Obama administration has come to a stunning conclusion: no doctors, no reform.

The administration says it can

-expand coverage;

-make care affordable;

-cut costs of doctors;

-offer incentives to implement a national EMR system;

-form a comparative effectiveness institute;

-create an alternative enrollment plan to compete with private plans;

-cut the profits of drub companies and health plans;

-force doctors and hospitals to bundle fees for high tech procedures;

-compel all businesses to pay for health coverage of employees;

-standardize Medicare payments in every region and hamlet in the land;

-even be able to push through legislation compelling every American to buy insurance.

But the administration admits it cannot cut out of whole cloth 50,000 more doctors now needed to serve the American people, expected to grow to 200,000 by 2019. It is a sad fact but it takes 8 to 10 years to create a new primarr doctor, and even more for specialists who are also in short supply.

To cut the shortage, proposals so far include:

• Increase payments to family physicians and internists.

• Increase enrollment in medical schools and residency training programs.

• Make greater use of nurse practitioners and physician assistants.

• Expand the National Health Service Corps, which help pays the educational debts of doctors and nurses in rural areas and poor neighborhoods.

• Support the medical home concept, which emphasize more primary care physicians providing comprehensive coordinated care.

• Subsidize the education of primary care doctors.

All of these proposals require more federal monies in the face of huge deficits. And they require expanding the federal mindset beyond Medicare and Medicare, which cover about 1/3 of Americans but are not representative of the care delivered by private plans for nonMedicare and nonMedicaid patients.

If the Obama administration is serious about expanding access with the ultimate aim of covering the entire population, it will surely come up with the money. And it had best gets its act together before 78 million baby boomers started entering the Medicare rolls in 2011.

And by the way, along the way, it will have to come to grips with the fact that there is a shortage in multiple specialties – general surgery, emergency room medicine, geriatrics, and obstetrics and gynecology – to name but a few.

In addition to more money, the government might think about letting up on this irritating and timeconsuming regulations that, other than inadquate payments, are the primary reason only 60% of doctors are accepting new Medicare patients and less than 50% take new Medicaid patients.

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