If 32 million people get health insurance in 2014 under health reform, will you still be able to find a doctor when you need one? That's a question a lot of people are asking, and no one truly knows the answer.
The Association of American Medical Colleges (AAMC) projects a shortage of 55,300 doctors in 2014 and estimates that could grow to 159,300 by 2025. The reason for the dramatic increase by 2025 is not just health reform but also the fact that many baby boomer doctors are nearing retirement. Another big problem is that doctors are choosing specialties that pay more than primary care, so even fewer will be running primary care practices.
To try to reverse that shortfall, the AAMC's Center for Workforce Studies has recommended that "medical schools increase enrollment by 30% by 2015," says Clese Erikson, director of workforce research. She adds medical schools are currently on "track to reach a 30% increase by 2018."But even those increases won't be enough to fill the gap that will likely emerge as more and more people seek medical care from doctors' offices rather than emergency rooms. "We believe that increased use of nurse practitioners and physician assistants will play a key role to ameliorate potential shortages," Erikson adds. More nurse practitioners and physician assistants will be needed in both primary care and specialty practices.
An even bigger question is what role nurse practitioners and physician assistants will play in providing patient care. If nursing groups have their way, they may even be running primary care practices. In fact, 28 states are considering legislation that would give nurse practitioners the right to practice on their own and give them the right to prescribe narcotics. The American Medical Association opposes these changes, arguing that they could endanger the patients.
But nurse practitioners already diagnosis patients during office visits and have a good record for referring the sickest patients to the doctor for care, notes Joanne Pohl, professor of at the University of Michigan School of Nursing. He says "nurse practitioners have a significant role" in addressing the physician shortage. "They need to have barriers removed so they can practice to their fullest preparation." Nurse practitioners can become "primary care providers of record for the increased numbers of patients who will have access to health care," and that unlike physicians, they "continue to choose to practice in primary care."
So will you be seeing a doctor or nurse practitioner when you seek out primary care? According to the 2009 Physician Survey on Primary Care, only 34% of primary care physicians say they are looking to increase their number of patients. About 38% say their current patient load is about right, while 18% say they have more patients than they would like, but are still accepting patients. Only 9% say they're not accepting new patients.
When asked what they will do with the surge in demand, 52.7% said they would hire more staff, 38.5% expect to work longer hours, 41.1% expect to lengthen time between follow-up visits and 32.1% expect to close their practice to new patients.
We can get a peek of what 2014 could look like as we watch the changes in Massachusetts in the wake of its health insurance reform measure. Dr. Michael Bihari, who spent most of his years working in health insurance administration, said that an increasing number of doctors in Massachusetts are not accepting new patients, and even those who are accepting patients require them to wait more than 40 days for an appointment. Today, he's the president of the board of a large community health center in Massachusetts. He said the clinic has seen its patient rolls jump from just 3,000 to 11,000 in the past four years.
He's found the biggest impact is on Medicare patients. He lives on Cape Cod, which has a large population -- 26% -- who are 65 or older. He's watched physicians move off the Cape or stop practicing completely because they can't afford to keep their doors open. He said "once a practice grows to 40% or 50% Medicare patients, the practice has trouble paying the bills" because of the low reimbursement rates.
While he supports the idea of nurse practitioners picking up the slack, he's found there is a shortage of nurse practitioners as well. He doesn't think there will be enough nurse practitioners to fill the gap. As is, he's having trouble recruiting nurse practitioners for the community health center.
So what will happen if there is a doctor shortage? In addition to the longer hours and additional staff predicted in the physician survey, the AAMC expects health car providers will lengthen the time between visits and use more phone and e-mail communication. It expects patients will wait longer to get appointments, which could increase the use of emergency rooms. It also expects patients will have to travel further to get care, be forced to see a different provider or not get care at all.
If you want to be sure to continue to see the same doctor after 2014, your best bet is to build a strong relationship starting now. While doctors may close their practice to new patients in 2014 or soon after, they likely will continue to see those who are already part of the practice.
Lita Epstein has written more than 25 books including The Complete Idiot's Guide to Social Security and Medicare and The Pocket Idiot's Guide to Medicare Part D.
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