Are there enough doctors for the newly insured?

Unless something changes rapidly, there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020.
TNS Regional News
Jan 6, 2014

 

Signing up for health insurance on the new state and federal exchanges was supposed to be the easy part of the Affordable Care Act. But the really dicey part, according to many health policy experts, is just beginning.

With the law fully in effect as of Jan. 1, they fear Americans who have enrolled in health insurance for the first time under the ACA are likely to discover that having coverage doesn’t guarantee them easy access to a primary care doctor, dentist or mental health professional.

Some changes in the works, such as the use of new technologies and allowing mid-level medical providers to perform some functions usually reserved for doctors and dentists, should improve health care access in the long run. “In the meantime,” said Linda Rosenberg, president of the National Council for Behavioral Health, “people are going to suffer.”

According to the Health Resources and Services Administration, the federal agency charged with improving access to health care, nearly 20 percent of Americans live in areas with an insufficient number of primary care doctors. Sixteen percent live in areas with too few dentists, and a whopping 30 percent are in areas that are short of mental health providers. Under federal guidelines, there should be no more than 3,500 people for each primary care provider; no more than 5,000 people for each dental provider; and no more than 30,000 people for each mental health provider.

According to the Association of American Medical Colleges (AAMC), unless something changes rapidly, there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020.

In some ways, the shortage of providers is worse than the numbers indicate. Many primary care doctors and dentists do not accept Medicaid patients because of low reimbursement rates, and many of the newly insured will be covered through Medicaid. Many psychiatrists refuse to accept insurance at all.

Christiane Mitchell, director of federal affairs for the AAMC, predicted that many of the estimated 36 million Americans expected to gain coverage under Obamacare will endure long waits to see medical providers in their communities or have to travel far from home for appointments elsewhere.

During the debate over the ACA, Mitchell said the AAMC pushed for the federal government to fund additional slots for the training of doctors, but that provision was trimmed to keep the ACA from costing more than a trillion dollars over 10 years.

There are various reasons for the shortages. Certainly a big contributor is the aging of the baby boomers, who may still love rock ‘n roll but increasingly need hearing aids to enjoy it. The growing medical needs of that large age group are creating a huge burden for the existing health care workforce. The retirement of many doctors in the boomer cohort is compounding the problem.

The federal government estimates the physician supply will increase by 7 percent in the next 10 years. But the number of Americans over 65 will grow by about 36 percent, according to the U.S. Census Bureau.

Money also is a factor in the shortages. During the course of their careers, primary care physicians earn around $3 million less than their colleagues in specialty fields, which makes primary care a less appealing path for many medical students.

In mental health, the problem is that much of the work is in the public sector, where the pay is far less than it is for providers in other medical specialties, who tend to work in the private sector. As an example, according to the National Council for Behavioral Health, a registered nurse working in mental health earns $42,987 as compared to the national average for nurses of $66,530.

But financial factors are not the leading reason that medical students are avoiding primary care, Mitchell said. In surveys of medical students conducted by AAMC, students valued “work-life balance” more than money when they were choosing their specialties. Because primary care often involves long hours and night and weekend calls, it is far less desirable to this generation of students.

“Half of the physicians in training are women,” Mitchell said. “You find more of them are looking for a career that might be compatible with part-time hours, that don’t involve being on call. Men are more engaged in child care today, and they have similar concerns as they consider their career choices.”

A steady stream of negative attention has made medicine in general a far less attractive career choice than it once was, according to Rosenberg of the National Council for Behavioral Health. Insurance headaches, pricey technologies, long hours and the risk of liability have convinced many talented students to eschew medicine as a career choice.

“Nowadays,” Rosenberg said, “the best and the brightest are talking about becoming investment bankers or going off to Silicon Valley.”

To some extent, dentistry created its own problem. Richard Valachovic, president of the American Dental Health Association, said today’s shortage of dentists can be traced to the closing of seven dental schools in the 1980s and 1990s. In 1980, he said, the United States produced 6,300 dentists. Ten years later, the number was down to 4,000.Why did the schools close? “There was a perception that we had conquered dental disease,” Valachovic said. “Kids weren’t getting cavities anymore so we thought we wouldn’t need as many dentists.” Dental health did improve, he said, but not for the poor and those without insurance.

Twelve new dental schools — smaller than their predecessors — have opened since 1997, Valachovic said, so the U.S. is back to graduating 5,700 dentists a year. But the ACA has made pediatric dental care coverage a requirement for all insurance, which will extend benefits to as many as 8.7 million children by the year 2018. Demand will far exceed capacity to produce dentists for years to come.

Despite the shortages, many believe that new technologies will extend the reach of medicine in ways that will ameliorate the problem.

For example, health care professionals can serve more people by using Skype or other telemedicine technologies to examine, treat and monitor patients. Similarly, patients can be fitted with electronic devices that remind them to take their medications and provide other guidance about their conditions. These and other technologies are already keeping patients out of hospitals and doctors’ offices.

Changes in the way medicine is delivered, such as the use of “medical homes” and “accountable care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. These organizational changes will make primary care physicians more important than ever, which might make primary care a more appealing — and lucrative — career choice.

A more controversial idea is to allow nurse practitioners, physician assistants, pharmacists and dental aides to do some of the work usually reserved for doctors and dentists. Many states have passed such legislation while others are eyeing similar measures. The Pew Charitable Trusts, which funds Stateline, has supported such efforts.

The American Dental Association, however, opposes allowing mid-level dental workers to perform some of the functions of dentists, such as routine preventive and restorative work. The organization, which represents 157,000 dentists, questions federal data on a dentist shortage, suggesting the problem is more of an uneven distribution of dentists.

Some groups representing doctors are resisting similar efforts to allow nurse practitioners to, for example, write prescriptions and admit patients to the hospital. But many believe the trend is unstoppable.

“Health care is not a zero-sum game where there’s a limited amount of care to be given,” said Polly Bednash, the head of the American Association of Colleges of Nursing. “If there’s more care needed than we can deliver in the world, we have to decide who else can provide quality care.”

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By Michael Ollove - Stateline.org (MCT)

©2014 Stateline.org

Visit Stateline.org at www.stateline.org

Distributed by MCT Information Services

Comments

Contango

Re: "there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020"

Pres. Obama along with progressive Democrats will pass legislation that there are more docs & POOF, problem solved.

'Hope and change' ya know?

Ben Crazy

Doctors will be expeted to work cheap, then the quality of care will dwindle!
Good job obama!

Unique perspect...

Supply and demand says that costs will then rise with a limited resource of health specialists and general care providers. I think this will/could prompt a change to the healthcare dynamic: more home diagnosing using available technology (Skype, med chats with registered clients, etc.), more available shifts to visit doctors - not just day hours as the economy has a global cast and much of the US work 3 shifts around the clock (only the ER does, nothing for normal office visits).

The former method of doctor visit the home back in the day can re-emerge via technology to provide benefit to the greatest of "customers" [patients]. quality of care is risked, but how many visits involve showing and describing symptoms - Skype and Facetime (and similar) can cover those bases adequately I would think.

Windy

And nobody saw this coming? Good grief!

Whiskey Tango F...

Collections, malpractice, wages, hours, and electronic medical records has created a great opportunity called boutique medicine. There are docs that have an annual membership and only see those who are their patients. They limit the group and don't report to the electronic records. NO SECURITY LEAKS! No pay, no medicine. The plumber gets paid 100% to fix the leak, why should the doc only get 30% because you are on government assistance? The doc can cut his work load to less than 1/2 if everyone pays. You will see more of this as we roll out our great new government run rules!!

methodman

So what is your point? What is "boutique medicine?" Plumbers paid100%? Workload in half? Blah blah blah blah. Wow. Hope u got insurance for the brain surgery you need so the doc Dont get stuck for 70%.

Contango

Re: "Plumbers paid100%?"

Point:

Just be thankful that the govt. doesn't have plumbing insurance or there would be a shortage of plumbers.

Wonder if you could get an overpaid, Washington, paper-pushing, liberal bureaucrat to clear a clogged toilet?

Nah! They're too ‘important’ for such 'menial' work.

"If you put the federal government in charge of the Sahara Desert, in five years there'd be a shortage of sand."

- Milton Friedman

Whiskey Tango F...

My health insurance is provided by my employer. It is part of my salary which I negotiated. I earned a degree in a field of study that was in demand. This way I don't have to worry about a minimum wage increase, or whether or not you ordered fries with that. I'm sure your Obozocare will provide you with the finest, non-english speaking, brain surgeon that money can't buy.

Windy

Just wait until the employer mandate kicks in. We'll ALL be up the creek without a stethoscope!

methodman

Maybe u could learn to communicate your point more clearly. Minimum wage. I Dont care what language they speak if they know what they're doing. They've got an app for language conversion. Degree. Pfft Degree in your field of expertise= an expensive piece of paper. You def sound like a racist tho.

propman

Whisky, you do know that insurance paid for by your employer will soon be taxed as part of your income under Obamacare?
Obamacare is nothing more than a lot of new taxes hidden behind a few popular changes that people wanted in insurance programs.

methodman

Shortage of plumbers because of plumbers insurance? Why would that happen?

Contango

Re: "Why would that happen?"

See WTF’s “point”:

“Why should the doc only get 30% because you are on government assistance?”

Inadequate reimbursement schedule.

Whiskey Tango F...

Re method... I am sure that you endured all four years of undergrad ($100k), four years of medical school ($160k+), four years of residency (aka work for a pittance) all to come into the workforce to only collect 30% of what you can bill out. Go ahead and do your job for 1/2 of your pay. A doctor requires one or america's best and brightest people. They can be anything they want. If the paycheck isn't there neither is the best and brightest... Your brain surgeon didn't graduate from community college.

methodman

Sounds like a lot of the best and brightest aren't even making to the table because of 250000 worth of debt to become a doctor.

Contango

Re: "250000 worth of debt to become a doctor."

You've made the "point": THAT'S why they need to be paid for their work.

Plus, medical malpractice ins. tends to take 50% or more of their income.

methodman

So wouldn't it be better for doctors if everyone has insurance? Please educate me. Sounds like your complaining that some doctors have annual memberships and " only see their patients." " If everyone paid, they could cut their workload in half." So are they only seeing the other patients to cover expenses? To me, a good doctor can't be paid enough. Thank God for all our care takers. The plumber only gets paid if the person he did the work for has it and doesnt try to screw him once the job is done. Insurance, medicaid, or cash if they'll still accept that or a payment plan. None of that then they go to the E.R. and none of it gets paid.

Contango

Re: "So wouldn't it be better for doctors if everyone has insurance?

Back to the "point": Medicaid and Medicare (and Obamacare) doesn't cover all of the costs associated with the services provided.

If plumbing ins. only covered 30% of the costs, how good of a job would your plumber perform?

How hard would you work if 70% of the cost of your labor wasn't paid?

methodman

If it covered 30% you'll be fixing your own pipes or be calling the "Emergency plumber". One way or another you're gunna get your pipes fixed. Then its up to u if u wanna actually pay the bill.

Contango

Re: "calling the 'Emergency plumber'."

But remember: There's a shortage of plumbers. Enjoy the wait.

methodman

Anyone can go to any E.R. in the state any be treated. Shortage of primary care physicians.

Contango

Re: "Anyone can go to any E.R. in the state any be treated."

They practice triage. Enjoy the wait.

methodman

I'm a big boy. I can wait my turn or if its that important they'll ship me out anyway. This ain't a gas station we're talking about. Obama probably implemented triage too.

Dr. Information

Many and soon to be most private dr offices will phase out Medicaid patients. why? Little to no reimbursement, takes forever to receive payment and way to many hurdles to jump through.

methodman

So why'd medicaid just expand then? They'll just go to the E.R. and it'll cost double.

Contango

Re: "So why'd medicaid just expand then?"

Vote buying for Pres. Obama and the Democrats.

Follow the money.

So how would YOU solve the doc shortage?

methodman

Medicaid was expanded by individual states. Gov. Kasich is one who was for the expansion. If doctors are only reimbursed 30% then obviously they won't be seeing medicaid patients. So the medicaid patient is going to go to the E.R. instead of the doctors office. Do you think the previous system was working any better? Would u be okay with the affordable Care act if a Republican president would have implemented it? Medicaid, insurance or not, treatment is not refused at the E.R. So docs dont wanna be in primary care. Offer tuition reimbursement for those who are practicing primary care. Nothings perfect except for your opinion and your wife's meatloaf. Its not a Republican vs Democrat thing like you n whiskey make it out to be. Are you mad u have to carry health insurance?

propman

Medicaid was expanded by some states at the FEDS (Obama's) request and an offer to pay the first 3 years then the states have to pay the bill. No matter if it is the Feds or the State it is we who get the bill
Obamacare doesn't have my support and whether it was democrats or republicans who passed it the bill is a failure.
By the way Obama care was passed by the Democrats and any input from the Republicans was tabled without being heard on the floor of the House or Senate. As such every failure of Obamacare is squarely the fault of the Democrats.

methodman

. Either through medicaid or higher insurance premiums and elevated hospital and doctors costs.The old system wasn't working. Maybe a Republican candidate can get elected and come in and make it perfect. I choose neither side. So why did a Republican governor opt to expand medicaid?

Contango

Re: "The old system wasn't working."

And you think that it's working now with the Obamacare mess?

Wait until the employer mandate starts kicking in and businesses drop their health plans and throw employees on the exchanges.

IMO, high deductible health plans (HDHP) & heath savings accounts (HSA) sold through the free market is a debate would having.

Gov. Kasich saw accepting the Medicaid funds as free money.

100% of the costs fall on the state after three yrs.

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