ACA to further stretch family doctors

By Burton Speakman


The change might not be immediate, but the Affordable Care Act is probably going to exacerbate shortages for primary-care physicians, some medical professionals say.

“It’s hard to predict the immediate impact,” said Tim Maglione, senior director for government relations for the Ohio State Medical Association.

Initially, there may not be much change because it will be less expensive to pay the fine, at least for the first couple of years, as opposed to paying for health coverage, he said.

“We won’t know anything for sure for at least six months,” Maglione said.

There are already issues with primary-care shortages, and this is going to make the situation worse, the question is how long will it take, he said.

Not knowing what is going to happen is making a lot of physicians uncomfortable, said Dr. James Shina, who practices primary care in Austintown.

Doctors already face issues from medical-insurance companies trying to keep medical costs down and malpractice insurers who tell doctors to run every test they can so they don’t miss anything, Dr. Shina said.

Now, the government is getting involved.

“We now have threats from every side,” he said. “When, in the last 100 years, has the government run anything that has come out great?”

This act is just causing more people to get in the way of doctors trying to treat patients while running a small business, Dr. Shina added.

The next problem is there are always winners and losers when it comes to legislation, he said. Private insurance companies win in this case because they can raise rates and have no additional risk.

“The expectation is that the cost for insurance in Ohio will skyrocket,” Dr. Shina said. “I can’t name any physician, even staunch Democrats that I’ve talked to in the past year, who are happy with this,” he said. “It’s just another obstacle in the way of patient care.”

There will be a lot more people in the Mahoning Valley trying to see family doctors, said Dr. Dominic Conti, who practices in Youngstown.

Doctors will be forced to either spend less time with each patient or work longer hours, he said.

“We’re not going to be able to accept every patient,” Dr. Conti said. “There are already local [family] doctors that are not accepting new patients.”

One of the keys to handling the anticipated shortage of family doctors is to convince medical-school graduates to stay in this area and become family doctors, he said.

“We have to convince them you can stay here and make a good living,” Dr. Conti said.

He said his practice would struggle to add another doctor even if they could find one, however.

“I already share a practice with another doctor and there’s only six exam rooms. We’re already kind of stepping over each other,” he said. “I don’t think we could add anyone without more space.”

Part of the Affordable Care Act includes nearly tripling the size of the National Health Service Corps. The corps provides medical students scholarships and loan-repayment incentives for providing primary-care services in needed areas.

“The feds probably need to double down in this area,” Maglione said.

Medical students can graduate with $200,000 in debt, and the government could do something to help students by eliminating or reducing those loans if they practice primary care in a rural area, he said.

There are also increases in payments for Medicaid and Medicare payments to primary-care physicians to make the field more attractive to new doctors graduating from medical school, Maglione said.

The bill provides $11 billion in funding over five years to support community health centers. There is $230 million being spent to train additional primary-care physicians, and there are expanded residency slots for primary care as a way to encourage more medical residents to pursue careers in that field.

The key of the ACA is to get people access to better medical care, preventive screenings and other health-care options that reduce health issues in the future, said U.S. Rep. Tim Ryan of Niles, D-13th.

The trend of people arriving at the emergency room for treatment of basic illnesses because they don’t have insurance “is the most expensive [trend] possible,” said Jonathan Archey, director of government affairs for the Ohio Hospital Association.

Training people not to come to the emergency room for primary treatment will take time, he added.

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