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Doctor Shortage?

Published: Tue, September 24, 2013 @ 12:00 a.m.


Associated Press


Getting face time with the family doctor could soon become even harder.

A shortage of primary-care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law next year. Doctors could face a backlog, and patients could find it difficult to get quick appointments.

Attempts to address the provider gap have taken on increased urgency ahead of the law’s full implementation Jan. 1, but many of the potential solutions face a backlash from influential groups or will take years to bear fruit.

Lobbying groups representing doctors have questioned the safety of some of the proposed changes, argued they would encourage less collaboration among health professionals and suggested they could create a two-tiered health system offering unequal treatment.

Bills seeking to expand the scope of practice of dentists, dental therapists, optometrists, psychologists, nurse practitioners and others have been killed or watered down in numerous states. Other states have proposed expanding student loan reimbursements, but money for doing so is tight.

As fixes remain elusive, the shortfall of primary care physicians is expected to grow.

Nearly one in five Americans already lives in a region designated as having a shortage of primary care physicians, and the number of doctors entering the field isn’t expected keep pace with demand. About a quarter million primary care doctors work in America now, and the Association of American Medical Colleges projects the shortage will reach almost 30,000 in two years and will grow to about 66,000 in little more than a decade. In some cases, nurses and physician assistants help fill in the gap.

The national shortfall can be attributed to a number of factors: The population has both aged and become more chronically ill, while doctors and clinicians have migrated to specialty fields such as dermatology or cardiology for higher pay and better hours.

The shortage is especially acute in impoverished inner cities and rural areas, where it already takes many months, years in some cases, to hire doctors, health professionals say.

“I’m thinking about putting our human resources manager on the street in one of those costumes with a ‘We will hire you’ sign,” said Doni Miller, chief executive of the Neighborhood Health Association in Toledo. One of her clinics has had a physician opening for two years.

In southern Illinois, the 5,500 residents of Gallatin County have no hospital, dentist or full-time doctor. Some pay $50 a year for an air-ambulance service that can fly them to a hospital in emergencies. Women deliver babies at hospitals an hour away.

The lack of primary care is both a fact of life and a detriment to health, said retired teacher and community volunteer Kappy Scates of Shawneetown, whose doctor is 20 miles away in a neighboring county.

“People without insurance or a medical card put off going to the doctor,” she said. “They try to take care of their kids first.”

In some areas of rural Nevada, patients typically wait seven to 10 days to see a doctor.

“Many, many people are not taking new patients,” said Kerry Ann Aguirre, director of business development at Northeastern Nevada Regional Hospital, a 45-bed facility in Elko, a town of about 18,500 that is a four-hour drive from Reno, the nearest sizable city.

Nevada is one of the states with the lowest rate per capita of active primary care physicians, along with Mississippi, Utah, Texas and Idaho, according to the Association of American Medical Colleges.

The problem will become more acute nationally when about 30 million uninsured people eventually gain coverage under the Affordable Care Act, which takes full effect next year.

“There’s going to be lines for the newly insured, because many physicians and nurses who trained in primary care would rather practice in specialty roles,” says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

Roughly half of those who will gain coverage under the Affordable Care Act are expected to go into Medicaid, the federal-state program for the poor and disabled. States can opt to expand Medicaid, and at least 24 and the District of Columbia plan to.

In Ohio, which is weighing the Medicaid expansion, about one in 10 residents already lives in an area underserved for primary care.

Mark Bridenbaugh runs rural health centers in six southeastern Ohio counties, including the only primary-care provider in Vinton County. The six counties could see some of the state’s largest enrollments of new Medicaid patients per capita under the expansion.

As he plans for potential vacancies and an influx of patients, Bridenbaugh tries to identify potential hires when they start their residencies — several years before they can work for him.

“It’s not like we have people falling out of the sky, waiting to come work for us,” he said.

State legislatures working to address the shortfall are finding that fixes are not easy.

Bills to expand the roles of nurse practitioners, optometrists and pharmacists have been met with push back in California. Under the proposals, optometrists could check for high blood pressure and cholesterol while pharmacists could order diabetes testing. But critics, including physician associations, have said such changes would lead to inequalities in the health-care system — one for people who have access to doctors and another for people who don’t.

In New Mexico, a group representing dentists helped defeat a bill that would have allowed so-called dental therapists to practice medicine. And in Illinois, the state medical society succeeded in killing or gutting bills this year that would have given more medical decision-making authority to psychologists, dentists and advanced practice nurses.

Other states are experimenting with ways to fill the gap.

Texas has approved two public medical schools in the last three years to increase the supply of family doctors and other needed physicians. New York is devoting millions of dollars to programs aimed at putting more doctors in underserved areas. Florida allowed optometrists to prescribe oral medications — including pills — to treat eye diseases.

The federal health care law attempts to address the anticipated shortage by including incentives to bolster the primary care workforce and boost training opportunities for physicians’ assistants and nurse practitioners. It offers financial assistance to support doctors in underserved areas and increases the level of Medicaid reimbursements for those practicing primary care.

Providers are recruiting young doctors as they gear up for the expansion.

Stephanie Place, 28, a primary-care resident at Northwestern University’s medical school in Chicago, received hundreds of emails and phone calls from recruiters and health clinics before she accepted a job this spring.

The heavy recruitment meant she had no trouble fulfilling her dream of staying in Chicago and working in an underserved area with a largely Hispanic population. She’ll also be able to pay off $160,000 in student loans through a federal program aimed at encouraging doctors to work in areas with physician shortages.

Access to care could get worse for some people before it gets better, said Dr. Andrew Morris-Singer, president and co-founder of Primary Care Progress, a nonprofit in Cambridge, Mass.

“If you don’t have a primary-care provider,” he said, “you should find one soon.”

Contributors: Associated Press writers Sandra Chereb in Carson City, Nev.; Carla K. Johnson in Chicago; Kelli Kennedy in Miami; Judy Lin in Sacramento, Calif.; Barry Massey in Santa Fe, N.M.; John Seewer in Toledo, Ohio; Chris Tomlinson in Austin, Texas; and Michael Virtanen in Albany, N.Y.


1NoBS(2836 comments)posted 2 years, 10 months ago

So the self-defined capitalists will celebrate the new imbalance in the supply and demand of health care, and the results for the average citizen will be higher doctors' fees. Wonderful.

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2DwightK(1537 comments)posted 2 years, 10 months ago

It's funny t o hear conservatives lamenting a doctor shortage. Won't the market solve this issue? An opportunity exists and resources rush to fill the need. If there is a doctor shortage, educate more doctors.

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3iBuck(231 comments)posted 2 years, 10 months ago

At no place in the article are "shortage" or "optimal number of doctors" defined, only the implication that the authors and editors believe there should be more, and cheaper, and better doctors. How good are the "doctors" or "physicians"? Would a smaller number of better doctors be an improvement, or would a larger number of doctors with a range of knowledge and ability be better?

Economics shows that, if you want more or better, you should pay more... not other people, the individual desirer of more and/or better.

"By 1860, there were more than 55K physicians practicing in the United States, one of the highest per capita numbers of doctors in the world (about 175 per 100K)... By 1963... the number of doctors per 100K people in the United States -- 146 -- at the same level it was at in 1910." --- Dale Steinreich 2010-05-16 "100 years of US medical fascism" _Ludwig von Mises Institute_ http://mises.org/daily/4276 visited 2012-07-04

257 physicians/100K in 2008
citing Health, United States, 2010 (Table 106) Centers for Disease Control and Prevention, National Center for Health Statistics. Available at: http://www.cdc.gov/nchs/data/hus/hus1...
visited 2012-07-04

146 doctors/100K in 1970
165 doctors/100K in 1975
193 doctors/100K in 1980
220 doctors/100K in 1985
234 doctors/100K in 1990
262 doctors/100K in 1995
266 doctors/100K in 2000
"In 1970 there were 146 doctors per 100K people and by 2008 it hit 322 per 100K."
visited 2012-07-04

"In 2010, there were 258.7 active physicians per 100K population in the United States, ranging from a high of 415.5 in Massachusetts to a low of 176.4 in Mississippi, according to the 2011 State Physician Workforce Data Book, Center for Workforce Studies — which is provided by the Association of American Medical Colleges (AAMC)."

See also:
which has a vested in interest in increasing applications to med schools.

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4walter_sobchak(2727 comments)posted 2 years, 10 months ago

You pose a valid point. However, doctors are not a commodity. The positions available in medical achools in the US is limited. Then, a student needs 4 years of medical school and then more years of internships and residency. Top that off with more years of training in a specialty. So, after 10 to 12 years of education and training, with a couple of hundred thousand dollars of debt (ehich is basically a second mortgage), the new doctor will either have to buy into an established practice, even if one of their parents is already there or they go to work for a hospital or care facility with deep pockets. Maybe a better solution would be to have medical schools run by the government to educate doctors that will then be required to staff government facilitied that will treat the poor.

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5candystriper(575 comments)posted 2 years, 10 months ago

The pharmacist and nurse practitioner will play a big role in delivering the 1950's care via skype. The corporate physician will over see dozens of PA's and rarely see patients.

So while the Affordable Care Act offers care for the masses...

Who will be able to afford the anti aging treatment that will cost millions? Will only the super rich be 100 years old with the mind and body of a 20 year old? Why, yes.

More important is how will California deal with the new anti aging black market? ...lol.

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6DwightK(1537 comments)posted 2 years, 10 months ago

Your solution may come to pass. We must make sure we have enough doctors to treat the population. I think we've been under served for years but didn't realize it because the uninsured simply didn't go to the doctor. Now that everyone will have insurance we'll start to see people show up in waiting rooms for treatment.

I read these articles and think it's rather unfair for people to blame Obama for getting more people care. The need exists. This legislation simply addresses the fact.

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7jojuggie(1727 comments)posted 2 years, 10 months ago

Dwight writes "it's unfair for people to blame Obama for getting more people care."
Evidently he didn't read about the KY families hospitalization premium increasing from $333.00 to $965.00 per month.
His Union buddies, today, all want waivers. I wonder why? Congressional staff members all want waivers. I wonder why? etc. etc.

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8DSquared(1788 comments)posted 2 years, 10 months ago

Under ODumbo Care, the only doctor you will see will be a Witch Doctor from his homeland of Kenya! Just one more industry that the Liberals screwed up!

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