Health Reform Law Could Worsen Doctor Shortage, Experts Say


Although the Affordable Care Act is expected to extend insurance coverage to an additional 30 million U.S. residents in 2014, experts say a physician shortage could prevent many newly insured individuals from accessing services, the New York Times reports.

Projected Physician Shortage

The Association of American Medical Colleges projects a shortage of about 62,900 physicians in 2015, and expects that number to more than double by 2025. AAMC estimates that even without the overhaul, the shortage would top 100,000 by 2025.

Along with the health reform law's Medicaid expansion and population growth, the increase in baby boomers becoming eligible for Medicare is contributing to the shortage. Medicare officials expect enrollment to reach 73.2 million in 2025, a 44% increase over current enrollment.

According to the Times, individuals typically still are able to obtain care during a physician shortage, but doing so often is "slow and difficult."

Dustin Corcoran, CEO of the California Medical Association, said that physician shortages cause many U.S. residents to "access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker."

Little the Government Can Do

Many experts say there is little that the government or medical community can do to close the gap before 2014, when the ACA fully takes effect, according to the Times. The Times notes that it takes about 10 years to train a physician.

Medical school enrollment has increased, but it has not kept pace with the population. In addition, fewer medical students are choosing to become primary care physicians, as the salary disparity between primary care and specialists grows.

Provisions in the ACA are intended to address the physician shortage, such as increasing Medicaid primary care payment rates in 2013 and 2014 and launching new training programs. The law is expected to increase the number of primary care physicians by about 3,000 over 10 years. However, communities nationwide need about 45,000 more primary care physicians, according to the Times.

Mark Smith, president and CEO of the California HealthCare Foundation, said that the shortage will force the health care system to "use the resources that we have smarter." He added that building more walk-in clinics, allowing nurses to provide more services and encouraging physicians to work in teams all could help address the shortage (Lowrey/Pear, New York Times, 7/28). CHCF publishes California Healthline.

Number of Retail Health Clinics To Increase

As a result of the looming physician shortage, more walk-in clinics are expected to be established in the next few years, the Los Angeles Times reports.

CVS MinuteClinic -- which is the largest retail clinic chain nationwide, with 600 locations -- will open another 100 clinics annually. Target is scheduled to open nine more clinics this week, for a total of 53. Meanwhile, Walgreen has more than 350 clinics and Walmart has nearly 150.

Some experts say it is unclear whether the clinics will create more unnecessary care, or if the proliferation of facilities will undermine efforts in the ACA to boost care coordination, particularly for individuals with complex and costly conditions (Terhune, Los Angeles Times, 7/30).

Tim Colling
The real issue here is that doctors and all other providers will eventually be paid by the government, especially under the healthcare takeover act that was deceitfully named the "affordable care" law. When the government decides to pay them less, providers will naturally be less inclined to work increasingly growing workloads for ever decreasing rates of government payment. Then the government can begin to REQUIRE providers to take all comers. After all, the Supreme Court just ruled that government can tax citizens if they don't buy health insurance. So, why can't it "tax" providers by making them work for less? It's a very slippery slope... And by the way, if you don't think the government can force doctors to take on patients that they don't want to take on, just ask the two doctors in San Diego County who were found to have violated the civil rights of two lesbians who wanted a child through artificial insemination, when they declined on religious grounds.
Wells Shoemaker
The headline in NYT & CA Healthline is misleading. The "health law" isn't worsening the shortage or the regional disparities, particularly in primary care. Those are regrettably already in place, and uninsured and disadvantaged people have been living awkwardly with access defiency for years. The "health law" will, however, make local systems visibly accountable for their ability to mitigate the impact of workforce shortages affecting the entire population. More doctors will help, eventually, but meanwhile smarter systems and expanded teams stimulated by the "health law" will be essential.
Marc Kashinsky
I guess what this report is trying to say is, the Republicans are correct. The US just can't afford to provide health care to everyone. Some people are going to have to sacrifice so that health care doesn't suffer for everyone. Maybe we do need to take their approach to health care. If you can't afford to pay for your own health care, then don't get sick, and if you do, please die quickly. You don't want to be a further drain on society.

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