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Will overhaul lead to doctor shortage?
Doctor holds out stethoscope
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Kai Ryssdal: So here's an interesting coincidence. The same day President Obama signed the health care bill -- that'd be Tuesday -- the medical school at Texas Tech University said it's going to start offering a three-year program for people who want to be primary-care doctors. Most medical schools, of course, are four years.
Texas Tech is reacting to long-standing predictions that we're facing a big shortage of MDs and guesses that that shortage's only going to get worse as health care reform kicks in and millions of new patients try to find doctors. Marketplace's Nancy Marshall Genzer has more.
NANCY MARSHALL GENZER: We'll need an estimated 13,000 new primary care doctors to treat the millions of new patients who will be insured by 2014 when health care reforms kicks in. So brace yourself.
LORI HEIM: There will be patients who get an insurance card, but they may well find that the practices in their area are closed to new patients.
Doctor Lori Heim is president of the American Academy of Family Physicians.
HEIM: People will be getting care that's delayed or forgoing care until it's more costly.
After Massachusetts overhauled its health care system in 2006, requiring almost everyone to get insurance, the number of doctors accepting new patients dropped 10 percent. So, more patients saw nurse practitioners. And patients started having group doctor appointments. Yep, you get to talk about your gall bladder in front of total strangers.
Erica Drazen says it's not as bad as it sounds. She's a health policy analyst at Computer Sciences Corporation just outside Boston. She's talked to patients who've had group appointments.
ERICA DRAZEN: So you listen to other patients problems. You can get tips from other patients. Now clearly if they're going to do a physical exam, they go off in a private room to do that.
That's a relief. The health care overhaul does attempt to alleviate the doctor shortage. There's more funding to train new family doctors and nurse practitioners.
And all the bickering in Congress about health care reform had an unintended benefit. The number of medical students going into family medicine increased by about 9 percent this year.
Dr. Atul Grover is a lobbyist for the Association of American Medical Colleges.
ATUL GROVER: All the discussion around the value of primary care that has gone on has really helped revitalize people's career interest in primary care.
Let's hope they don't change their minds.
In Washington, I'm Nancy Marshall Genzer for Marketplace.
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It takes 50 years to change workforce design in a situation such as primary care workforce. First there needs to be a national decision with regard to the level of primary care. According to HRSA and census data the US will need 440,000 primary care physicians for 400 million people after 2050. Then the US must graduate 35 class years of annual graduates at the required level to reach this level. A pure primary care training source that results in permanent primary care would require this 440,000 divided by 35 class years with 90% active in primary care for about 14,000 annual permanent primary care graduates needed. The US does not have a permanent primary care design. Five out of six sources of primary care have more than a majority of new primary care graduates found in specialty care. The US has only half of the primary care production and retention that it needs to reach sufficient primary care using physician and non-physician clinician sources. So it will take a decade for the nation to increase production to the required primary care workforce. This requires 14,000 permanent primary care graduates or 17,000 family medicine residency graduates or 100,000 to 120,000 annual graduates of internal medicine, nurse practitioner, and physician assistant programs combined.
Any discussions other than about a massive increase in the number of graduates entering and remaining in primary care is premature and the US is discussing almost anything in primary care other than what is needed.
Since the United States graduates 28,000 annual primary care graduates from six sources and only has 34% of these graduates entering primary care with more departing primary care in the years after graduation, perhaps these distractions are easier to discuss than real progress toward a solution.
Robert C. Bowman, M.D. www.basichealthaccess.org
As the New HCR becomes reality, what will we expect to see as providers of Vision care, within the Medical field?
I am an experienced licensed Optician with a small practice here in Oregon.
I have a part time independent Optometrist that provides the Exams.
Am I to see an increase in Vision care insurance programs coming available, where patients will "now" have the ability to go where they like, or will we see more "closed panel systems", where those Patients are mandated to a particular group?
Like VSP or "Vision Service Plan of California", a licensed "Optician Owned" practice, is not considered a valued component of health care through their eyes.
This is the only insurance company out there I know of, that has these set standards of exclusitivity.
This is a privately based insurance group that is "owned by Optometrists."
We as Opticians are closed out from providing service through this group even if we have a Doctor in house.
To become a service provider, They also mandate I sell 51% of my lives work to the Doctor, to be considered as a provider.
I am hoping this sort of closed market share becomes dissolved very soon. It is not at all fair to the Optician who is also state board certified, or to the patient.
I believe each health care provider or facility has the rights to provide medical services to the public as long as that provider and facility are state licensed and can provide quality care.
I do believe the certification process is also most important to provide a shared demographic within a community. All the "Three O's" Ophthamology,Optometry and Opticianry, are integral within the eye care field. Neither of the three are less than the other. The Public needs the options for Care.
The full effect and cost of the overhaul remain to be seen. People are increasingly taking an interest in and a responsibility for maintaining their most important asset - their health. A shortage of traditional allopathic doctors will only increase the demand for natural wellness care practioners, products and services. The internet will continue to be "the great equalizer" of the 21st century bringing natural wellness care information to the masses.
I was stunned and certainly disappointed after hearing Nancy Marshall Genzer’s story on Market Place last week concerning the demise of Primary Care Medicine in America. She reports that fewer doctors are choosing this less lucrative tract at a time when the demand for primary care will sky rocket with upcoming health insurance coverage. She goes on to say that “gasp†patients might have to see nurse practitioners, or even, “gasp, gasp†participate in group visits.
What she has failed to see is that health care is changing, but not just in cost and insurance coverage. Gone are the days when patients take pills they don’t know the name of, because “that’s the doctor’s business.†Gone are the days when the only reason you went to the doctor or hospital is when you were sick or dying.
Patients are much more sophisticated now. They research every aspect of their health before they even hit your exam room. They want knowledge and fact based information on a huge variety of topics. Developing good health habits and preventive care is coming to the forefront of medicine. Health Care is changing to Care of Good Health.
Nurse Practitioners are highly trained individuals who deliver excellent care. Their training also includes intense focus on principles of patient education and appreciation of the ethnic and social differences of patient groups. And believe me, providing education in a group setting is an ideal and very successful method. Some of the things that happen in group visits are amazing. I’ve seen countless patients make huge and meaningful improvements in their health from participating in group visits. They learn they are not alone in their struggles. They learn from other patients asking questions they were too afraid to ask. Sometimes they even learn they are not as bad off as they thought.
Yes, I am a nurse practitioner and yes, I manage group visits. Maybe Nancy’s next story could be about some of the innovative ways health care can meet future demands.
Based on what I've read, the government used to subsidize doctors' education. That program was significantly reduced during the Clinton administration because they were worried about having *too many* doctors. It might be a good idea to reconsider that change--*if* Congress ever cuts spending to sane levels; we can't afford any new subsidies now.
Why not mention that not every problem needs a fully trained MD, and all the other health care providers will boost the number of jobs available? As an uninsured American I am so tired of being treated like a category of nuisance in your stories about health care. Nancy, objectivity does not mean that we need to be dehumanized.
I wonder why Obama failed to mentioned "group care," this great new way to treat patients in his recent speeches leading up to the vote. Perhaps hospitals can covert all the patients rooms into old-fashion wards. If its good enough for the 3rd world, its good enough for Obama-Care.
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