The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor. Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come calling. Who is going to be available to treat them?
It takes 8-10 years for an under supply of physicians to be corrected because physicians have to go through medical school and residency. There has been no up swing in physicians choosing primary care specialties for years and, in fact, the shortage is predicted to be 46,000 full time physicians by 2025 (Association of American Medical Colleges). Now add millions of new patients, baby boomers reaching Medicare and you have a disaster in the making.
I have been sounding this alarm for at least 10 years as I saw what our lack of policy and attention has done to primary care. Comprehensive Internal Medicine is one of the hardest lines of medicine. Patients are complicated, the work is long and arduous and primary care doctors save the "system" millions of dollars. Why it has not been recognized and rewarded in the United States is a mystery...especially when every other industrialized nation has build their health care policy on primary care.
When thousands of new primary care doctors are needed to care for our population, doesn't it seem foolish to cut residency training slots and pay specialists 2 to 4 times as much? Some suggestions at this late hour are to use nurses or physician assistants to fill the gaps. Others have suggested shortening the residency time. Both are terrible ideas for our population as medicine is becoming more complicated, not less.
I watched as Anesthesiology and Radiology became the most sought after residencies. I don't think there was a sudden interest in putting patients to sleep or reading X-rays in the dark all day. When I was a senior resident an anesthesiology friend encouraged me to switch immediately to Anesthesiology. He said "You'll work half the time and make four times the money." He was right and I saw what happened in the years to follow.
What can we do today?
- Increase primary care residency program slots effective 2011 at teaching hospitals and pay more for those programs to increase.
- Enact forgivable loans for all medical students who choose primary care and practice it for at least 5 years. You can't enslave people forever.
- Raise the Medicare reimbursement by...oh let's say 40%. Even that may not be enough to turn this ship around. The inequities are just too large.
- Allow even higher reimbursement for primary care doctors who practice in rural communities or under served areas. The pressures in those areas are magnified and should be rewarded.
- Develop true systems of care where physicians treat the most complicated patients and nurse practitioners handle routine care.
It is time to quit admiring the problem and get to work solving it.