• Yes, there is a shortage of primary care doctors

    Jessica Marcy has a piece out at Kaiser Health News on how the increased Medicaid coverage under the PPACA is scaring people because of the shortage of primary care doctors in some areas:

    States in the South and Mountain West, which traditionally have the lowest rates of primary care physicians, could struggle to provide medical services to the surge of new patients expected to enroll in Medicaid under the health overhaul and federal incentives may not provide much help, according to a report issued today by a Washington health research group.

    The study, by the Center for Studying Health System Change, noted that many of the states with low numbers of primary care doctors per capita are also expecting some of the highest percentage increases in Medicaid enrollment. The study’s author — Peter Cunningham — estimated that Medicaid programs could grow by as much as 38 percent in states with low rates of primary care physicians, while only about 15 percent in those states that have high rates of the doctors—those in the Northeast and the Mid-Atlantic regions.

    “Things are probably not going to be pretty in those states that have a hard time” recruiting primary care doctors, said Alwyn Cassil, the center’s director of public affairs.

    I’m going to ask for a pause in the conversation here. Longtime readers know I get frustrated when a problem that already exists (and has for some time) gets blamed on reform. Yes, we do have a primary care shortage in the United States. But it isn’t new, and it isn’t because of the PPACA:

    We have fewer – far fewer – pediatricians, general internists, and family physicians per population than any other comparable country. Moreover, as you can see from the chart above, this issue stretches back over years, if not decades. It’s just not new.

    If you want to fix this, I’m all for it. Refusing to do so, and then complaining about an increase in coverage to the uninsured because the problem exists is a bit cynical, though.

    Anyway, back to the article:

    Many physicians currently do not accept Medicaid patients or limit the number they will see, saying the reimbursement rates are too low. That has raised concerns about whether the new enrollees will be able to find doctors.

    I know there’s an anti-Medicaid current in the news and general psyche right now, but this is a problem for everyone, not just Medcaid. There’s been a primary care shortage in the past, there is one now, and there will be one in the future whether we increase Medicaid enrollment or not. If we just gave everyone private insurance, there would be a shortage.

    In fact, the shortage can be used as a reason not to give anyone insurance in the future, because it will make the shortage worse. Is that the argument people want to make? We shouldn’t reduce uninsurance at all because there aren’t enough docs?

    Many docs choose not to become primary care physicians because they don’t make as much as specialists. The solution is to incentivize them to become primary care docs. The rest of this is just smoke and mirrors.

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    • If only health reform did something about the primary care workforce.

      Oh wait, $250 million:

      http://www.healthcare.gov/news/factsheets/creating_jobs_and_increasing_primary_care_providers.html

      I usually love KHN and I’m very disappointed to see that’s not once mentioned in that article.

    • Current financial incentives work to increase the number of specialists and reduce primary care doctors. Specialists earn much more than primary care providers so it is no surprise that doctors who may have entered medical school intending to go into primary care suddenly discover a love for dermatology or ENT practice.

      One way to increase the number of primary care doctors would be to start paying them better (and/or reduce the overcompensation of specialists and procedures). This distortion of payment has been well documented and is the result of the specialist societies capturing the RBRVS committee.

      That said, it would be good to train more doctors also (as long as they don’t go into specialties). Perhaps more nurse practitioners also if you can overcome the organized medicine resistance to this competition.

    • I’m interested in all of the chatter about the nurse practitioners profession growing and filling the void of the shortage of primary care doctors.

      Also, is it truly bad that the students are entering the specialists path? Part of me wants to think that is a good thing to have skilled professionals focusing on a specific field, perhaps I am missing something.

      Good read!!! keep up the good work.

    • We have fewer – far fewer – pediatricians, general internists, and family physicians per population than any other comparable country.

      And yet there are many adequately trained and experienced foreign born and trained doctors who cannot practice in the USA! My nurse anesthetist friend tells me in the Miami FL area there are many former Cuban doctors working as nurses and Doctor love having them on the team. I have a friend who was a Doctor in Egypt but is unable to practice here.

      So the connection is that the shortage is a result of government policy (state Gov. policy) and it impacts on the lack of access to care and costs. So why not address this problem first? If care is too expensive for people to afford why not first try to see how cheap you can make it? I am for subsidizing the poor but we should also work directly on the cost.

      It reminds me of CRA people could not afford homes so CRA was enacted to make it easier to get a loan. Why not focus n bringing down the cost of homes? I think that you could build adequate housing for under $30,000 per unit maybe under $20,000 per unit. Many places in the USA have slow growth policies that keeping home prices higher than they would otherwise be.

    • ” My nurse anesthetist friend tells me in the Miami FL area there are many former Cuban doctors working as nurses and Doctor love having them on the team. I have a friend who was a Doctor in Egypt but is unable to practice here.”

      The training varies quite a bit in some of those countries. If we were to follow this path, we should develop more uniform training standards. We have tried that path with poor results. Regardless of govt policy, I will be hiring docs with at least some of their training in the U.S. or training in a first world OECD country.

      Steve