March 13, 2014

Is a Doctor Shortage Coming to Your Neighborhood?

Will you have trouble finding a new doctor in the years ahead? Will it become harder to make appointments with your current doctor? Will you spend less time talking with your doctor than before? Will your care be compromised? Two recent pieces in the New York Times suggest maybe... and probably not.

Sounding the Alarm
The Association of American Medical Colleges predicts that in ten years we’ll need 130,000 more doctors than medical schools are now producing. That shortfall sounds pretty scary.

Baby Boomers are graying. Today, 12.9 percent of all Americans are 65 and older. In 2030, that percentage will rise to 19. Seniors have more health issues than young people, and require more attention from doctors. 

Now that the website issues have apparently been mostly resolved, Obamacare is pouring new patients into doctors’ offices. By the end of this decade, about 30 million MORE Americans will have health insurance. Since we now have about 2.4 physicians for every 10,000 Americans, we’ll need about 90,000 additional doctors by 2020 just to maintain that ratio.

There’s no question: when you’ve got medical coverage, you’re much more likely to see a doctor.

Then There’s Medicaid
In California alone, there are now about 7 million Medicaid patients. Over the next two years – thanks in part to the Affordable Care Act – officials estimate an additional 2 million people will join the Medicaid rolls. That’s NINE million Medicaid recipients in one state alone.

While California state official downplay alarms about doctor shortages, physicians there are finding it hard to keep up with the growing insured patient population.

But it’s worse for Medicaid patients in California (where the program is called Medi-Cal), than for other patients. Why? According to a study published last year in the journal Health Affairs, only 57% of doctors in the state accept new Medi-Cal patients. After New Jersey, California has the lowest percentage of Medicaid-accepting doctors in country.

Why do docs refuse Medicaid patients? Simple. The program provides low reimbursement rates to participating physicians, who must also deal with the considerable red tape, which adds administrative costs. The ACA mandated increases in Medicaid rates to approximate payments for Medicare, but states have been slow to implement those increases, which – in any case -- will expire at the end of 2014.

Finding specialists who accept Medicaid is even harder. Dr. J. Mario Molina, CEO of Molina Healthcare, which covers Medicaid patients in California and nine other states, has beefed up his staff – doctors, nurses, case managers, call center operators -- to cover increasing demand. Addressing the challenging of recruiting specialists, he said, “Rheumatology is difficult, neurosurgery is difficult, orthopedic surgery is difficult.”

Stop Ringing the Alarm!
Not everyone sees such a grim future.

Massachusetts implemented an ACA-like program in 2006. Since then, about 400,000 new people in that state have become insured, and no crisis has occurred.

Yes, there are more seniors in the system now, in all states. But these patients can be treated more regularly in “sub-acute” facilities, not hospitals, reducing requirements for constant doctor involvement.

New technologies are available to reduce inpatient treatment and care. Sensors can monitor patients remotely, and recommend more timely intervention. There are new devices and new drugs that eliminate costlier, more complicated treatments. Newer, minimally invasive procedures – like laparoscopic surgeries – sharply cut inpatient hospital stays. New research suggests that half the traditional radiation treatments for some cancers work just as well.

It’s only reasonable to think more and more efficient and time-saving procedures will become standard medical procedures in the years ahead.

Expand Roles for Other Practitioners
The reach of doctors to care for an expanding patient base will be greatly increased by enabling these professionals to do more:
  • Physician’s assistants
  • Nurse practitioners
  • Nurses
  • Healthcare aides
  • Pharmacists
  • Dietitians
  • Physical therapists
  • Psychologists

Proponents of change and enhanced efficiency suggest strategies like these:
  • Broaden the scope of practice laws (a change some doctors strongly oppose) so those other healthcare providers – like nurse practitioners --  can do more,
  • Change laws that prohibit telemedicine across state lines,
  • Reform liability laws that force professionals to stick with ponderous present practices only to avoid liability risks, and
  • Create incentives that reward technology investments that will save money down the road.

Co-authors of the NYT’s “no shortage” piece end their argument this way:
Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of non-physicians in caring for patients. Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other health care workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better.

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The two New York Times articles referenced above:

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