Where will all the doctors be found? - Tucson Local Media: Columns

Where will all the doctors be found?

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Posted: Wednesday, May 30, 2012 9:38 am

With the United States Supreme Court announcing its verdict on Obamacare in June, it is time to remind us of the adverse impact of this law on physician availability.

Currently, the United States has approximately 921,823 medical physicians. Of this total, there are 320,795 Primary Care Physicians (excluding OB/GYN). The U.S. population is approximately 306 million. Subtracting 46 million “uninsured” leaves a “net insured” population of 260 million.

There are 123 Primary Care Physicians per 100,000 “net insured” population. Adding 46 million “uninsured” to the covered health care population reduces the number of Primary Care Physicians from 123 per 100,000 population, to 105 per 100,000 population. This is not only a 16 percent drop in Primary Care Physicians per 100,000 population but also recognition that this statistic represents very real health care rationing. America has a physician shortage now.

A study by the Association of American Medical Colleges found that if the current pattern of declining first-year enrollment at American medical schools continues, “the country will have about 159,000 fewer doctors than it needs by 2025.” In light of the 16 percent drop in Primary Care Physicians per 100,000 population, how many new physicians will the United States require to maintain a ratio of 123 Primary Care Physicians per 100,000 population?

Mathematically, the United States will need an additional 54,205 Primary Care Physicians. Primary Care Physicians represent about a third of the physician population. Another study calculated that the United States would need to produce an additional 10,000 physicians annually to avoid a significant physician deficit by 2025. This 10,000 is over and above the numbers graduating now.

Assuming (1) that a third of the 10,000 physicians needed go into Primary Care, (2) that graduating physicians go into Primary Care at the rate they have over the last few years, and (3) excluding a growing population to keep the calculation simple, it will take over sixteen years to reach 54,205 additional Primary Care Physicians. During this 16-year period, health care will be rationed due to a lack of physicians. And a growing population will only exacerbate the situation.

None of the bills floating through Congress specifically address the lack of physicians. The United States has a shortage of Primary Care Physicians now. Faced with the growing shortage of Primary Care Physicians, federal officials are considering several proposals.

One would increase enrollment in medical school and residency training programs. However, finding sufficient numbers of qualified future physicians and maintaining medical schools standards are issues that have not been solved.

Another proposal would encourage greater use of nurse practitioners (NP) and physician assistants (PA). Depending on individual State laws, Nurse Practitioners and Physician Assistants can diagnose and treat patients under a Physician’s supervision. Increasing the number of NPs and Physician Assistants in a timely manner faces the same obstacles as increasing the number of qualified physicians.

A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods. If increasing the number of Physicians, Nurse Practitioners and Physician Assistants is problematic in the first two proposals, it is certainly a non-starter in this instance.

Adding approximately 46 million uninsured to the population mix only makes finding a physician more difficult because the marketplace of physicians is adequately serving 260 million people. Then add the great difficulty of finding a physician if you have Medicaid. Too many physicians are refusing to see Medicaid patients or, at best, will only see Medicaid patients as a very small percentage of their practice.

Why?  Physicians have a “usual and customary” fee structure. Medicare generally pays at about 80 percent of “usual and customary.”  Medicaid pays at 80 percent of Medicare, or 64 percent of “usual and customary.”  Physicians cannot cover their overhead by accepting Medicaid. The compromise is to have a practice that is primarily insurance covered and allow Medicaid patients as a single digit percentage of the total practice.  

Obamacare has exacerbated the problem of physician shortages.  This is what happens with socialist centralized planning. It never works.

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