A shortage of primary-care physicians in the nation is expected to worsen when more than an estimated 30 million people gain health insurance by 2014 through the Affordable Care Act.
Ohio is expected to have a shortage of 5,031 of those doctors by 2020 no matter what happens with the Affordable Care Act, said Megan Smith, director of communications for the Ohio Academy of Family Physicians.
Because of the number of low-income people in the Mahoning Valley, the act will have a larger impact locally, said Rudolph Krafft, program director of the family medical residency program at St. Elizabeth Health Center in Youngstown.
“A large number of the people that we treat are uninsured or underinsured,” he said.
The key to having enough primary- care physicians is getting more medical students interested in primary care as a specialty, Krafft said.
“The problem is that primary care is the lowest in terms of pay. You can almost reverse the lowest pay list for specialties and find the most popular specialties,” he said. “These students pay so much to attend medical school, and they know it will be easier to pay off those loans with a higher-paying specialty.”
A limited number of residency openings also will make the problem worse, Krafft said. The number of students in medical schools is increasing, but the number of residency openings remains consistent.
“In a few years for the first time, there might not be enough residency openings for all U.S. medical school graduates,” he said.
Traditionally U.S. programs took foreign medical-school graduates to fill spots, but with more graduates and no additional funding for residency programs, American students may not be able to find a spot, Krafft said.
One positive aspect of the new health-care law is that people who had previously been uninsured or underinsured now can see a primary-care physician and their care would be greatly improved, Krafft said.
The act provides more in payment for primary care from Medicare and Medicaid, he said. Hospitals also will receive additional funding when and if everyone has insurance.
“Right now the hospitals already treat everyone regardless of if they have insurance,” Krafft said.
Meanwhile several initiatives in the state seek to help improve access to primary care despite the shortage of physicians, Smith said.
One of the larger programs focuses on training doctors, medical students, nurses and medical team members to deliver care as a team to support more patients, according to the Ohio Academy of Family Physicians.
The Affordable Care Act also will cause additional work in the medical community, said Tim Maglione, senior director of government affairs for the Ohio State Medical Association.
“New systems are needed to be put in place to take care of the additional people,” he said.
A team approach may be used more widely with a physician leading nurses, psychiatrists and social workers, Maglione said. Some hospitals and physician practices are working on developing this approach.
Some plans call on greater use of nurses and physician assistants to allow primary- care doctors to treat more patients, Krafft said.
The goal of the act was a good one, to increase the public’s access to health care, Maglione said, adding that several issues in the act will need to be revisited before it goes fully into effect in 2014.