Thursday, October 15, 2009

Reform Bills Essentially Ignore Doctor Shortage

I don’t mean to sound like a broken record, but for the record, I shall.

I have long maintained - in my book Obama, Doctors, and Health Reform and in previous blogs - that increased coverage without more doctors is meaningless and that the next big crisis will be lack of access to doctors.

Why? Because there will be no doctors there. To praphrase Gertrude Stein’s, “There will be no there there.”

This crisis will come to a head when 78 million baby boomers begin to join Medicare in 2011, or if 25 million now uninsured get coverage and start seeking doctors. This crisis is already being played out in Massachusetts, where waiting times to see primary care doctors are now two to three times the national average.

Where will the doctors come from? Beats me. The American Academy of Family Physicians predicts we will soon be 40,000 primary care doctors short. Worse yet, the overall shortage of doctors will climb to nearly 160,000 by 2025, according to the Association of American Medical Colleges.

The House and Senate overhaul bills are anemic in addressing the problem. They offer a 10 percent bonus for primary care doctors over five years, will marginally increase Medicare payment rates, and will redistribute about 1,000 unfilled residency positions to teaching hospitals that commit to creating more primary care residencies. This is unlikely to impress medical students, who know that specialists make twice the income in half the time as primary care doctors.

Congress seems unmoved by the shortage. A proposal backed by Senate Majority Leader Harry Reid, D-Nev., and the teaching hospital lobby to add 15,000 Medicare-funded medical residency positions -- a 15 percent increase that would favor more primary care training -- was considered dead on arrival because of its $10 billion price tag over a decade.

Dr. Darrell Kirch, CEO of the Association of American Medical Colleges, said extra training slots for primary care amount to a “drop in the bucket.” He noted that after Massachusetts in 2006 required all citizens to have health insurance, the demand for care quickly overwhelmed the state's doctors. "It’s a huge issue that concerns us greatly," says Kirch, whose association represents all 130 medical schools and nearly 400 major teaching hospitals.

Ken Raske, president of the Greater New York Hospital Association. Giving millions of Americans health insurance, while not increasing the doctor supply is a recipe for trouble in his view. And Deval Patrick, Massachusetts governor, has said, “Coverage without access is meaningless.”

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