Monday, February 23, 2015

The Physician Shortage: ObamaCare’s Achilles Heel

Not even Achilles will bring all his words to fulfillment.

Homer (700 BC), The Iliad

The next big political are crisis will be lack of access to doctors. This will be aggravated by 78 million baby boomers entering Medicare in 2011 and a dramatic expansion caused by millions of uninsured citizens entering the market.

Richard Reece, M.D., Obama, Physicians, and Health Reform, 2009

It‘s one thing to promise health care coverage to all Americans, the underlying goal of ObamaCare.

It’s quite another to give them access to physicians.

Coverage, unfortunately, is not the same as access. the two are not equated. ObamaCare expands coverage but exacerbates the access problem.

Because of a series of factors - expansion of Medicaid, increase of health exchange plans for the uninsured, the aging population with 10,000 more Medicare patients each day, accelerating hospital employment of physicians, rapid declines in physician private practices, larger numbers of women physicians, young physicians seeking more balanced lifestyles, rising medical education debts of $150,000 or more, persistent unpopularity of primary care among medical school graduates, the lid on federal funding of residency programs, the inability of American medical schools to expand fast enough to meet the demand for doctors – an access crisis is upon us.

A daunting, often cruel dilemma for patients, newly covered and seeking a doctor, confronts the health system and the Affordable Care Act.

What good is expanded coverage for the uninsured without doctors to cover the wave of 32 million new patients looking for doctors to treat them?

As Richard “Buz” Cooper, MD, an expert on physician shortages, trenchantly remarked in a Health Affairs 2002 article, “Without adequate numbers of physicians, the health system cannot function.”

The demand for new medical residency graduates is staggering. Physicians now graduating from U.S. residency programs report receiving 50 more recruiting inquiries. The American Association of Medical Colleges reports a shortage of 50,000 qualified physicians. That number is expected to peak at 150,000 to 200,000 over the next decade. American medical schools graduate 17,500 new physicians each year, not nearly enough to meet demands.

The U.S. has room for 30,000 physicians residency programs, but Congress has capped federal funding for these programs. To fill the gap, residency programs must be discontinued or filled with foreign medical school graduates. This is already occurring in many programs. And, of America’s practicing physicians, 25% are foreign-trained and that percentage may grow to address the shortage.

Solutions vary as to what to do. U.S. medical schools are ramping up enrollments by 30% or more. Nurse practitioners and physician assistants numbers are growing exponentially, and some are entering independent practices, supplementing or replacing physicians. Off- shore medical schools in the Caribbean, 18 of them, have turned out more than 15,000 graduates, and U.S. hospitals have had positive experiences with these graduates and are happy to have them, Cell phones containing health care guidance are being touted as partial replacements for physicians. Retail clinics are sprouting every day in pharmacy chains and in discount stores in malls. And locum tenens doctors are roaming the land, trying to fill in the gaps created by physician shortages.

I have been aware of the mounting physician shortage for more than 30 years. I wrote about it in my 1988 book, And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota m, in my 2009 book Obama, Doctors, and Health Reform, and I have written over 30 blogs on physician shortages in my Medinnovation and Health Reform blogs. The physician shortage is a multidimensional problem. To see what I have written about the shortage, to my blog and enter the phrase “physician shortage” in the search box.

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