Public Plan Facts

Enjoy the wait. Thanks “reform” plan wanted to call your attention to editorial from physician blogger on the implications health care reform will have on all of us…. enjoy:

Reform’s Great, But We Need More Doctors

Health reform has passed, and the United States is poised to join the rest of the industrialized world in providing most of its citizens with affordable health coverage.

But having health insurance doesn’t necessarily mean it will be easy to find a doctor. Even before reform, reports projected a shortfall of 40,000 primary care physicians over the next decade. Thirty-two million newly insured Americans, plus the millions of baby boomers entering Medicare age, will only make this shortfall worse.

As a primary care doctor in New Hampshire, I have had the opportunity to observe the effects of health reform in neighboring Massachusetts, which enacted a similar approach to universal coverage in 2006.

To its credit, Massachusetts covers 97 percent of its residents, the highest in the country. But its wholly unprepared primary care system was unable to handle the 500,000 newly insured patients looking for a regular doctor. According to the Massachusetts Medical Society, a primary care internist had an average wait time of 50 days for new patients, with almost half refusing to accept to new patients.

When Amherst, Mass., family physician Kate Atkinson decided to accept newly insured patients, she was forced to close her doors six weeks later. She told the Boston Globe that “there were so many people waiting to get in, it was like opening the floodgates,” saying that her office is getting “10 calls a day from patients crying and begging.”

And this is a state that already has the highest number of doctors per capita nationwide. It’s frightening to imagine how other parts of the country, most of which have significantly fewer primary care doctors, can handle the influx of patients if Massachusetts can’t.

Any hope to bolster the primary care work force, unfortunately, is not on the horizon.

With medical students graduating with an average educational debt exceeding $150,000, new doctors overwhelmingly choose to become specialists, which offer salaries several times more than those of primary care doctors. In the 2010 residency match, fewer than half of family practice residency slots were filled by American medical graduates, compared with more than 95 percent in fields like radiology, anesthesiology and orthopedic surgery.

Furthermore, nurse practitioners and physician assistants, who can help alleviate the shortage, are also enticed by the lucrative allure of specialty care. As Newsweek recently reported, “almost half of current nurse practitioners and physician assistants work in specialty practices, where the money is.”

Health reform does try to help primary care, through modest improvements to Medicare and Medicaid primary care clinician payments, better funding of loan repayment programs and pilot programs for new primary care models. But these incremental solutions fail to appreciate the enormity of the problem.

Nor do they address the phenomenon of physician burnout currently plaguing the field. A survey published last year in the Annals of Internal Medicine found that nearly half of primary care doctors reported practicing in a work environment “strongly associated with low physician satisfaction, high stress … and [an] intent to leave.” Indeed, almost one-third said they were likely to leave their practice within two years.

At a time when primary care physicians are needed most, health reform does little to relieve these frustrated doctors of the unreasonable time pressures and onerous bureaucratic requirements that worsen their practice conditions and obstruct their patient relationships.

Providing affordable health care to an additional 32 million Americans is certainly worth celebrating. But whether our beleaguered primary care system can meet the challenges that lie ahead will be critical in determining health reform’s success or failure.

Kevin Pho, a primary care physician in Nashua, N.H., blogs at and is on Twitter @KevinMD.


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