Implications of the Present and Future Doctor Shortage

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult.

Annie Lowrey and Robert Pear, “Doctor Shortage Likely to Worsen with Health Law,” New York Times,  July 28, 2012

July 29, 2012 -  Well, I see the mainstream media  is finally beginning to acknowledge one of the glaring deficiencies  of the health care law – a present and future doctor shortage. 

I’ve been repeatedly predicting that a political crisis will become manifest about 2015 – when  30 million more Medicaid and underinsured  and the first wave of 78 million Medicare eligible baby boomers  start looking for doctors and can’t find any.

How could this be in an affluent nation in which even primary care doctors make an average of $200,000, specialists twice that much, and all doctors are gainfully employed? 

I shall tell you why.  

Medicine isn’t fun anymore. And it isn't  particularly profitable either.  MBAs often make more money over the long run ,  spend years less acquiring an education, have far less  educational debt, and run a far less risk of being sued.  

Furthermore,  multiple surveys show massive demoralization among doctors (see "Health Reform and the Decline of Private Practice,"  The Physicians Foundation in survey conducted by Merritt Hawkins, 2010). Pessimism is equally shared among young and mid-career physicians (Aubrey Westkee, “Young Physicians Less Optimistic Due to Health Reform,” Physician Practice, April 28, 2012).

Why  should you become a doctor if the following factors are rendering medicine less attractive as a career (Testimony of  Mark Smith, president of Merritt Hawkins, the nation’s largest physician recruiting firm before House of  Representatives, July 19, 2012)?

1. Flat or declining reimbursement
2. Growing regulatory and administrative paperwork
3. Malpractice insurance costs
4. The implementation of information technology
5. Medical education debts
6. The effects of health reform

The New York Times article is not helpful in suggesting how to alleviate the doctors shortage. After saying the U.S.. is likely to be 120,000 doctors short by 2025, the article  says,

” 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. “

The articles goes on to comment that by 2012, there will be 73.4  million Americans on Medicare compared to 50.7 million today.  Population growth,  aging, and more health-law induced-Medicaid recipients will futher spur demand.

What to do?   Here are a few modest suggestions, which will never hear form the New York Times,  an Obamacare backer.

·         Advance age of Medicare entry to 67, may even to 70, over course of next 5 years.

·         Means test for Medicare.

·         Offer Medicare and Medicaid recipients optional private voucher plans.

·         Let states operate their own Medicaid plans subject to certain federal oversight provisions.

·         Repeal and replace Obamacare.

·         Make cost-sharing by patients more evident by expanding health savings accounts linked to high deductible plans.

·         Sensitive physicians to health costs by having them neogotiate with HSA-cost-sensitized patients.

·         Enhance cost-competition between health plans by making them bid for nationsl  business across state lines.

·         Let Americans have the same benefits offered to  government employees and national politicians on government employee health benefit plans

·         Lower premiums for individuals and the self-employees by giving  them  the same tax benefits enjoyed by corporations.

.    Pass national tort reform bill.

Tweet:  Expanding coverage under health law will speed doctor shortages and will make it difficult for people to find doctors.