Obamacare will not cause a doctor shortage says the NY Times. Here is why and where they are wrong.

doctor prescription

Obamacare will not cause a doctor shortage says the NY Times. Here is why and where they are wrong.

A recent article in the NY Times states that there will not be a doctor shortage based on the experience of Romneycare in Mass. You should read this opinion because although technically correct, the problem will be in the expansion of Medicaid.

Our system is in dire need to reform, and to do that properly, we need to get back to basics, expand the core of who does primary care and what part of primary care (chiropractors have always been primary care for musculoskeletal problems so they are a natural fit), family, internists and nurse practitioners can do primary care for a range of non musculoskeletal problems while their expertise in the musculoskeletal realm is not in their main comfort zone (the same can be said for chiropractors who look at systemic disease issues such as diabetes).

Many specialists will find their practices getting slower as there are fewer referrals from a growing primary care doctor base handling problems they would otherwise have referred out. Their solution is to embrace primary care (we are already seeing this happen, and even some cardiologist are running ads for patients).

Fewer tests ( a good thing since most are negative and of little value) and a greater amount of time spent by primary care doctors to figure out what is wrong (less costly, but money well spent) will bring us in line with what is commonly done in other countries who have not adopted the 10 minute office visit (3 minutes talking and writing, 7 minutes with EHR system notes) and of course, the time the doctor spends during lunch interpreting and logging tests that are mostly negative.

If this sounds like a rant, it is not since it is the truth and it is why most primary doctors are frustrated and moving on the larger practices or hospital owned clinics who handle the day to day hassles, negotiate better pay for the doctors and of course, end up feeding more tests into the system since they are there to make money, not treat patients.

Getting back to the waits and the doctor shortages, these will occur in the Medicaid realm since in NJ, doctors are not lining up to treat patients for $23.50 per visit or $7 for chiropractors to treat their patients, endure the paperwork headaches and do charity care by contract, while they lose their financial shirts. An Aetna rep called us to ask how we could get more doctors to sign up, and my response was to pay them, since after years of reducing fees for practices, and most practices do not have the cash flow or the appetite for charity care because of this, the only people seeing Medicaid patients will likely be big hospital clinics that can negotiate better rates.

With these clinics overloaded already, the huge influx will clearly lead to long waits there. The rest of the system will figure itself out because the doctors will go where the money is. If the money floods into primary care and away from specialties with the patients, doctors will go into primary care and solve the problem. If done properly, and we do see fewer tests, the cost of an MRI would likely come down markedly due to market forces.

Will we, the public benefit from this with lower costs of insurance coverage? That remains to be seen but so far, on the exchanges, the insurance companies have responded by limiting out of network coverage more, limiting networks based on cost, not effectiveness which will be bad policy.

Check out the NY Times article here

No, There Won’t Be a Doctor Shortage

By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL

IN just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.

he road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks.

Shortage forecasters point to two major factors. One is an aging population. The proportion of Americans who are 65 and older will increase to 19 percent in 2030 from 12.9 percent today, according to federal projections. Second, Obamacare will insure 30 million more Americans by the end of the decade, dramatically increasing demand for physicians. Extrapolating forward from today’s 2.4 physicians per 1,000 Americans would mean we will need at least 90,000 more physicians by 2020, or so the reasoning goes.

Regardless of your political views, there are good reasons to be skeptical of these predictions. Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey. Massachusetts’s experience may differ from other areas, particularly rural regions, but the results of reform there suggest shortage fears are exaggerated.

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