With the health care bill now passed through both the House and Senate it is estimated that about 30 million people currently without health insurance will be able to see a doctor. However, there may not be a sufficient number of primary care physicians to care for this increased patient load. Studies show that the number of students enrolling in family medicine fell more than 25% between 2002 and 2007.
The major reason is the lower income of primary care physicians as compared with specialty doctors. With student loans averaging more than $100,000., it is not surprising that new doctors are choosing to specialize in more lucrative practice areas. Another major factor contributing to the impending shortage is that the health care bill lowers reimbursement rates under Medicare, the purpose of which is to forestall doctors from ordering unnecessary tests and procedures.
In response to the shortage, medical schools will be adding 3,000 slots to first year students by 2018. However, in 1997, the House and Senate placed a limit on the number of Medical residencies in an effort to cut costs under Medicare, which pays for most of this training. It costs Medicare about $100,000 per residence or a total of approximately $9 billion according to a report submitted in June 2009 by the Medicare Payment Advisory Commission. These residency caps remain in place with the result that increased enrollment may not be sufficient to meet the demand for care; after all, it does no good to increase student enrollment if these students will be unable to participate in a residency.
Compounding the shortage crisis is that newly eligible patients will now be flooding into doctor’s offices alongside elderly patients. According to the U.S. Department of Health and Human Services, in 2009 there were 17,000 less doctors than needed in both urban and rural areas. The Association of American Medical Colleges predicts that this shortage could increase to 159,300 by 2025.
An amendment to the current Health Care bill calling for the addition of 15,000 primary care residences was created last December by Senate Majority Leader Harry Reid (D-Nevada) along with Charles Schumer (D-N.Y.), Bill Nelson (D-Florida), among other sponsors. According to Atul Grover of the Medical College Association, this amendment will cost Medicare about $1.5 billion. Because the House and Senate are trying to keep costs down, this will limited the actual number of residences created.
One suggestion to overcome the doctor shortage is to increase the responsibilities of nurse practitioners. When people need medical services, those services need not always be administered by a physician. In most states, nurse practitioners must be under the supervision of a physician and are restricted from prescribing medication. Medicare also typically reimburses nurse practitioners at a lower rate than doctors.
