Is a Health Care Crisis on the Horizon?
By Jeremy Howell, MHA, Adjunct Professor of Healthcare
If there was any doubt, the re-election of President Barack Obama on November 6, 2012, made it clear, the Patient Protection and Affordable Care Act (ACA) is here to stay. Full implementation of the law is required by 2014, allowing patients, physicians, employers, and other stakeholders two more years to prepare for the impending changes in health care in the United States.
What are the patient impacts?
Scholarly analysis shows that the ACA may result in a crisis: a shortage of primary care physicians. To get an idea of how patients may be impacted on the national level, it is important to look at the situation patient’s face in Massachusetts, where health insurance has been mandated since 2006. According to the Massachusetts Medical Society, the addition of 440,000 newly insured residents through the state's health care reform law has resulted in a shortage of primary care physicians. The increase in the number of people who qualify for medical services has forced many primary care physicians to close their practices to new patients. Another worrisome concern is lengthy wait times. Family medical appointment wait times have trended upward from 36 days in 2008 to 45 days 2011 (in Franklin County, the average wait time is 205 days!). In spite of the lengthening wait times, patients in Massachusetts give healthcare services overall a healthy 87 percent approval rating.
Will there be enough physicians to go around?
A recent article on family medicine describes the effect that ACA and other factors will have on primary care in the United States. Researchers estimate that the nation will require 8,000 additional primary care physicians in the next 13 years. An additional 30 million Americans will qualify for coverage once ACA goes into full effect in 2014. The numbers translate into calls for care that will not be met. Given the peak nationwide projections, each year 17,800,000 primary care requests for appointments will not be fulfilled.
Are salaries to blame?
A principal reason for the shortage of primary care physicians is in the discrepancy between their pay and the higher pay of specialists, particularly surgeons. The number of medical school graduates entering family medicine fell from 8,162 in 2000 to 6,757 in 2007, as reported by the Association of American Medical Colleges. Furthermore, recent studies by the Council on Graduate Program Education show that fewer than 20% of U.S. medical students are choosing primary care. To meet this impending crisis in health care, the ACA provides $1.5 billion over a five year period from 2011 to 2016 in order to expand the National Health Service Corps and increase the number of primary care physicians, nurse practitioners, and physician assistants.
If the goals are not met, 30 million people in this country will qualify for medical coverage that cannot be assured. Dr. Randy Wexler of the John Glenn Institute of Public Service and Policy has sounded the alarm stating “Coverage does not equal access.” The ACA is clearly here to stay and we have a lot of catching up to do in order to keep a crisis at bay.
What can be done to overcome the potential primary care physician shortage in the U.S. and meet the needs of an increased patient population?
Jeremy Howell is an adjunct professor in CTU's College of Healthcare. A career officer with the U.S. Navy, he is a Lieutenant the Navy's Medical Service Corps and is currently stationed at Naval Hospital Bremerton, Washington. He holds his Master's in Health Administration from the U.S. Army-Baylor University, and his undergraduate degree from Embry-Riddle Aeronautical University. Opinions expressed here within are solely those of the author and do not necessarily reflect the position of his employer(s).
Image credit: Flickr/Raymond Larose