Primary care physician shortage expected to worsen

Those newly insured under federal health care law will increase demand for doctors
Associated Press
Sep 11, 2013

 

Getting face time with the family doctor could soon become even harder.

A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law next year. Doctors could face a backlog, and patients could find it difficult to get quick appointments.

Attempts to address the provider gap have taken on increased urgency ahead of the law's full implementation Jan. 1, but many of the potential solutions face a backlash from influential groups or will take years to bear fruit.

Lobbying groups representing doctors have questioned the safety of some of the proposed changes, argued they would encourage less collaboration among health professionals and suggested they could create a two-tiered health system offering unequal treatment.

Bills seeking to expand the scope of practice of dentists, dental therapists, optometrists, psychologists, nurse practitioners and others have been killed or watered down in numerous states. Other states have proposed expanding student loan reimbursements, but money for doing so is tight.

As fixes remain elusive, the shortfall of primary care physicians is expected to grow.

Nearly one in five Americans already lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn't expected keep pace with demand. About a quarter million primary care doctors work in America now, and the Association of American Medical Colleges projects the shortage will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade. In some cases, nurses and physician assistants help fill in the gap.

The national shortfall can be attributed to a number of factors: The population has both aged and become more chronically ill, while doctors and clinicians have migrated to specialty fields such as dermatology or cardiology for higher pay and better hours.

The shortage is especially acute in impoverished inner cities and rural areas, where it already takes many months, years in some cases, to hire doctors, health professionals say.

"I'm thinking about putting our human resources manager on the street in one of those costumes with a 'We will hire you' sign," said Doni Miller, chief executive of the Neighborhood Health Association in Toledo, Ohio. One of her clinics has had a physician opening for two years.

In southern Illinois, the 5,500 residents of Gallatin County have no hospital, dentist or full-time doctor. Some pay $50 a year for an air ambulance service that can fly them to a hospital in emergencies. Women deliver babies at hospitals an hour away.

The lack of primary care is both a fact of life and a detriment to health, said retired teacher and community volunteer Kappy Scates of Shawneetown, whose doctor is 20 miles away in a neighboring county.

"People without insurance or a medical card put off going to the doctor," she said. "They try to take care of their kids first."

In some areas of rural Nevada, patients typically wait seven to 10 days to see a doctor.

"Many, many people are not taking new patients," said Kerry Ann Aguirre, director of business development at Northeastern Nevada Regional Hospital, a 45-bed facility in Elko, a town of about 18,500 that is a four-hour drive from Reno, the nearest sizable city.

Nevada is one of the states with the lowest rate per capita of active primary care physicians, along with Mississippi, Utah, Texas and Idaho, according to the Association of American Medical Colleges.

The problem will become more acute nationally when about 30 million uninsured people eventually gain coverage under the Affordable Care Act, which takes full effect next year.

"There's going to be lines for the newly insured, because many physicians and nurses who trained in primary care would rather practice in specialty roles," says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

Roughly half of those who will gain coverage under the Affordable Care Act are expected to go into Medicaid, the federal-state program for the poor and disabled. States can opt to expand Medicaid, and at least 24 and the District of Columbia plan to.

In Ohio, which is weighing the Medicaid expansion, about one in 10 residents already lives in an area underserved for primary care.

Mark Bridenbaugh runs rural health centers in six southeastern Ohio counties, including the only primary care provider in Vinton County. The six counties could see some of the state's largest enrollments of new Medicaid patients per capita under the expansion.

As he plans for potential vacancies and an influx of patients, Bridenbaugh tries to identify potential hires when they start their residencies — several years before they can work for him.

"It's not like we have people falling out of the sky, waiting to come work for us," he said.

State legislatures working to address the shortfall are finding that fixes are not easy.

Bills to expand the roles of nurse practitioners, optometrists and pharmacists have been met with pushback in California. Under the proposals, optometrists could check for high blood pressure and cholesterol while pharmacists could order diabetes testing. But critics, including physician associations, have said such changes would lead to inequalities in the health care system— one for people who have access to doctors and another for people who don't.

In New Mexico, a group representing dentists helped defeat a bill that would have allowed so-called dental therapists to practice medicine. And in Illinois, the state medical society succeeded in killing or gutting bills this year that would have given more medical decision-making authority to psychologists, dentists and advanced practice nurses.

Other states are experimenting with ways to fill the gap.

Texas has approved two public medical schools in the last three years to increase the supply of family doctors and other needed physicians. New York is devoting millions of dollars to programs aimed at putting more doctors in underserved areas. Florida allowed optometrists to prescribe oral medications — including pills — to treat eye diseases.

The federal health care law attempts to address the anticipated shortage by including incentives to bolster the primary care workforce and boost training opportunities for physicians' assistants and nurse practitioners. It offers financial assistance to support doctors in underserved areas and increases the level of Medicaid reimbursements for those practicing primary care.

Providers are recruiting young doctors as they gear up for the expansion.

Stephanie Place, 28, a primary care resident at Northwestern University's medical school in Chicago, received hundreds of emails and phone calls from recruiters and health clinics before she accepted a job this spring.

The heavy recruitment meant she had no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She'll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages.

Place said the federal law turned needed attention to primary care as a specialty among medical students.

"Medical students see it as a vibrant, evolving, critical area of health care," she said.

Even so, many experts say the gap between doctors and those gaining care under the health reforms in many parts of the country will not close quickly. Access to care could get worse for some people before it gets better, said Dr. Andrew Morris-Singer, president and co-founder of Primary Care Progress, a nonprofit in Cambridge, Mass.

"If you don't have a primary care provider," he said, "you should find one soon."

 

Comments

Contango

Re: "Getting face time with the family doctor could soon become even harder."

But...but...but...Pres. Obama PROMISED that more Americans would get better service and increased benefits for less money.

He wouldn't ever lie would he? :)

The Big Dog's back

Hey, how about we pay for the unemployed to go to school to become Doctors?

KnuckleDragger

Look at the demographics of those who are long term unemployed. Many are over the age of 50. By the time they completed medical school and a residency they would be close to retirement age. Also, many are uneducated without a high school diploma. In what world do you know of a high school dropout that has went to medical school?

YoMamma

Nope he is a honest as the night is black!

SamAdams

The shortage of medical professionals is actually understated here because, thanks to the usual bias coming out of AP, it wasn't mentioned how many doctors are retiring early, and how many medical schools are seeing decreased enrollment. Why might that be? Because medicine is hard? Because student loans are expensive? Nope. It's because of all of the headaches and assorted accompanying nonsense that are part and parcel of Obamacare. Awesome.

The New World Czar

The ratio of graduating doctors now going to work for others instead of their own private practice has rapidly increased over the past 25 years, falls under the same thinking...why deal with it? It's only going to get worse.

coasterfan

Any program as large as the Affordable Care Act is certain to have growing pains while being implemented. Of course, Republicans are doing everything they can to make the transition as rocky as possible. They are mistaken if they think that Americans won't notice.

A temporary shortage of doctors is NOT a good reason to delegitimization the ACA. it's a reason to take a pro-active stance and train more doctors. I, for one, believe this means that the ACA has created the need for thousands of new high-paying jobs. Will Republicans do the right thing (for once) and increase funding for education, and vote FOR increasing availability of student loans and grants?

If conservatives aren't part of the solution - and they aren't - they are, by default, part of the problem.

KnuckleDragger

Actually the shortage of primary care doctors dates back 20 yrs. The fact is that a doctor can make more money by specializing and have a better lifestyle. With the advent of obamacare and the ever decreasing reimbursement for primary care by medicaid and medicare, there is a reason there is a shortage. This started long ago, and continues to trend downward.

Contango

Re: "train more doctors."

Typical Progressive nonsensical sophistry.

Those of your ilk will not be satisfied until the State controls every and all means of production and crushes any remnant of a free market economy.

Nemesis

Coaster misses the fact that the shortage is because doctors are CHOOSING to retire early, and fewer people are CHOOSING to go to medical school, because Obamacare means they will work harder for less income. Supply and demand won't be denied, Coaster.

Of course you could use the Soviet approach - if a kid shows aptitude, he's told he WILL go to medical school and practice medicine or his parents will be sent to die in the gulag.

coasterfan

Sam: Any bias from the AP pales in comparison to that of Fox News. Those inside the Fox bubble, of course, are completely unaware of this. They are like fish, who have no idea that they are in water...

SamAdams

...which is why anybody who doesn't get news from MULTIPLE sources these days is an idiot. Ever directly compared stories running on both CNN and Fox? It's illuminating. More interesting still is getting the actual facts and then comparing those with both stories! I'm not going to outright condemn one over the other. I'm just going to say that if you take EITHER as gospel, you're going to stay as ignorant as you were before you started reading/listening.

KURTje

This is easy - apply the same health that Nancy Reagan & Nancy Pelosi get to US!

Nemesis

Oh, there was a clause in the ACA that required all members of Congress and their staff members to be under it. In the past year, some members have seen half their staff leave for the private sector. What did they do? Pass a bill that now exempts them!

goofus

Wondering when the left will wake up.A lamestream media source has merely reported a feature in Obamacare that Fox news has said for a while now. Darn Kool Aid drinkers.

Kramer

Lower reimbursement rates +
increased insurance company paperwork nightmares +
government intervention and regulation +
sky-high malpractice insurance premiums +
obamacare =
Who the heck wants the headaches, student loans and losing 8 years of your life in school.

tk

Obviously doctors from other countries don't mind the headaches. They come here in droves to practice medicine. Go to one of the larger hospitals, check the interns and residents. You will be hard pressed to find one from the US.

SamAdams

Well, they DID come here in droves! Who knows if that will continue once Obamacare REALLY kicks in! Meanwhile, ask yourself: If socialized medicine is so awesome, why didn't they stay where they were, eh? If money doesn't matter as much as healthcare in and of itself, why didn't they heal people at home, hmmm?

Nemesis

They'll stop, because now it will be no better here than it is where they came from.

Kramer

That's because as bad as it is here it's still worse in most other countries who, by the way, tend to be much more government-centered in their management of healthcare. We're catching up though!

Informed

This was a problem long before Obamacare. A former area doctor with a large practice recently left the area to specialize. Part of the reason--insurance companies expecting him to spend no more than 15 minutes per patient. Insurance companies try to control the medical field and tell doctors what to do. It's ridiculous.
Add to that the whole medical school situation. It is horribly expensive. Plus, it's model for requirements hasn't changed much over the years, despite some doctors advocating for that change--there is no reason that a general practitioner needs to have 2 years of college chemistry and a year of physics and extremely high level mathematics to get into medical school. Many doctors have tried to emphasize that medical schools need to look more at listening and social skills, and the ability to both analyze and synthesize information, abilities that can be learned by subjects other than chemistry and physics. Ask your family practice physician when was the last time he had to do a chem formula. The answer--college.

OSUBuckeye59

There's at least one very key part of the article:

"Stephanie Place, 28, a primary care resident at Northwestern University's medical school in Chicago, received hundreds of emails and phone calls from recruiters and health clinics before she accepted a job this spring. The heavy recruitment meant she had no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She'll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages."

Place has a student loan debt of $160k. That is an incredible amount of debt to pay off, therefore it's in her best fiscal interest to seek the highest overall total compensation position she can find such that she can then settle her debt as quickly as possible. But according to this report, http://www.medscape.com/features..., 'Family Medicine' doctors are the 3rd lowest-compensated physicians in the U.S., with 'Pediatric' doctors compensated slightly less. And those practicing in Family Medicine are making a minimum of 50% less than those in the top-earning specialties. And as the report points out in later data tables, doctors continue to "drown in paperwork". I couldn't find in the report if overhead & malpractice insure is included in the salaries listed, though I'm guessing what's listed is closer to net.

From a pure financial standpoint, it's not in a physician's maximum earnings potential to either be in or stay in family practice, especially when they're saddled with student loan debt well in excess of $100k. And for Place, even with a yearly compensation of $175k minimum, it will take her several years to pay off her student loans.