Patients Will Have Coverage, But No Doc

Preface: The following Op-Ed piece has appeared in The Chicago Sun Times, The Boston Herald, and The Tampa Tribune in recent days. I reprint it here because I have recently interviewed Louis Goodman and Timothy Norbeck for Modern Medicine, and I work closely with The Physicians Foundation.

BY LOUIS J. GOODMAN AND TIMOTHY B. NORBECK

Now that the health-care bill has passed and the smoke has cleared from the acrimonious debate -- if only for a little while -- it seems appropriate to reflect on how this significant legislation will impact our health-care system.

We don't know anyone who would oppose, on moral grounds, insuring everyone, and that includes us at the Physicians Foundation. Some have argued that the overall cost of the legislation may be prohibitive. While that argument goes beyond our expertise, we do believe that there is an important issue that has been ignored.

Many groups and think tanks seem to agree that there is a shortage of practicing physicians in the United States, especially those in primary care. These entities, including the Association of American Medical Colleges, point to what they see as serious shortages of as many as 100,000 physicians over the next 10 or 15 years.

The Physicians Foundation is a nonprofit organization created in 2003 to help physicians, in an increasingly difficult practice environment, to continue
delivering high-quality health care. In 2008, the foundation, in collaboration with Merritt Hawkins & Associates, undertook a comprehensive survey of all primary care physicians in the U.S.

The results were dramatic and distressing regarding difficulties they are encountering in sustaining their medical practices.

What was also telling and relevant to the discussion on the physician work force were the following:

• 63 percent said increasing paperwork has caused them to spend less time per patient.

• 76 percent said they were either at "full capacity" or are "overextended and overwhelmed."

• Less than 6 percent assessed their colleagues' morale as positive, and 78 percent reported that over the past five years, the practice of medicine has become less satisfying.

Because of these factors, 49 percent of physicians reported that, over the next one to three years, they intended to reduce the number of patients they see or to stop seeing patients entirely due to retirement, working part time or seeking non-medical jobs.

The entire survey is at www .physiciansfoundation.org. It is also available in a new book, In Their Own Words, in which physicians explain growing impediments to the delivery of patient care, including difficulty working with managed care organizations; liability insurance/defensive medicine; non-clinical paperwork; increasing demands on time; onerous government rules; declining reimburse- ments as their practice costs are escalating, and a shortage of primary care physicians.

In view of the influx of 30 million more insured patients into our health-care system, these findings are sobering. How will there be enough doctors available to take care of everyone?

For the past 25 years, the number of physicians completing training in the U.S. has remained flat at about 24,000 a year. During that time, a handful of new medical schools has been added, and enrollment is gradually increasing. The Association of American Medical Colleges has initiated a plan to increase medical school enrollment 30 percent by 2015, but that won't help unless the number of medical residencies available for them, now fixed by law, is increased as well.

To its credit, Massachusetts attempted to insure all of its citizens in 2006. According to the Massachusetts Medical Society, the state is now suffering a critical shortage of primary care physicians." Not surprising is that expanded insurance coverage -- regardless of its noble objective -- has caused an increase in demand for medical services. But there hasn't been a corresponding increase in the number of doctors.

Many Massachusetts residents now have insurance coverage but can't find a physician. The medical society also found in its 2009 survey that 56 percent of Massachusetts physicians in internal medicine aren't accepting new patients. And new patients fortunate enough to secure an appointment with a primary care doctor have an average waiting time of 44 days!

It is obvious that the U.S. physician work force and the number of medical residencies available must be increased -- and rather quickly -- in order for physicians to cope successfully with 30 million new patients. Washington has basically ignored an issue that will greatly affect patient care and that must be addressed now.

Louis J. Goodman is president and Timothy B. Norbeck is executive director of the Physicians Foundation, a Boston-based nonprofit that works with physicians to improve the health-care system.