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Will “Obamacare” make it harder to see a doctor?

Will “Obamacare” make it harder to see a doctor?



Physician Shortage?

For those who already have trouble getting to see their physician or, even worse, cannot find one, the shortage of physicians is all too real.  One estimate puts the existing shortage at 9,000 physicians nationally.

The bad news is the problem will only get worse.

The shortage is most acute among primary care physicians (PCP) (internists, pediatricians, general and family practitioners, and OB / GYNs).  According to the Association of American Medical Colleges (AAMC), we will have 45,000 fewer Primary Care Physicians than we will need by 2020.

The Affordable Care Act, often referred to as Obamacare, expands health insurance coverage to millions of Americans who are currently uninsured.  How many in this population actually purchase insurance, even with the assistance of premium tax credits, is uncertain.  Whatever the exact number turns out to be, health care reform will increase the demand for services.  The Manhattan Institute for Policy Research estimates the Affordable Care Act will create a shortage of 4,950 Primary Care Physicians.

But while health care reform is a contributing factor to the shortage, it is not the primary cause.  The same study puts the overall shortage at 30,000 by 2025.

The fact is the supply of primary care physicians cannot meet the future demand for their services.

In 1988, 38% of medical students chose primary care as their career, according to one study.  This number rose to 50% in 1998.  However, today only 16% to 18% of medical students plan to practice primary care.

As important as Primary Care is, many medical students would rather go into a subspecialty.  The reasons are simple.  Primary care physicians work long hours.  They earn far less than many specialists.  They carry significant student debt and, as the primary physician providing care to patients, they are often under considerable stress.

PCPs are not the only practitioners facing a shortage. Specialists such as general surgery, neurosurgery, and emergency medicine will also face critical shortages in the years to come, according to an article appearing in the December 20, 2012 issue of

Contributing to the overall physician shortage is the fact that nearly one-third of all physicians are over the age of 50 and many of these physicians are planning to retire within the next decade.

The general population in this country is getting older, as well.  This puts further pressure on physician services.  As Americans get older, they need more medical care.  Population growth will also add to the problem.  In the report produced by the Manhattan Institute, these two factors, along with shifts in demographics, are the primary reasons explaining the increasing demand for primary care.

Health care reform tries to address the physician shortage by providing funds to increase the number of medical school graduates who choose primary care.  The act also provides funds to train more physician assistances (PAs) and nurse practitioners (NPs).  But many experts say this funding is not enough.

Increasing the number of Internal Medical residents who choose primary care over a subspecialty would help alleviate the problem.   Some have suggested higher rates of reimbursement for primary care under Medicare and Medicaid may encourage medical residents to choose primary care as their career path.

Some also suggest restructuring of a physician’s practice into a Medical Home. Transforming a physician’s practice into a Medical Home would free up the physician to see only the patients that need physician attention. Physician assistances (PAs) and nurse practitioners (NPs), working in the physician’s office, would see the balance of the patients.

However, not everyone thinks the Medical Home is the answer to the problem.  An article appearing in the August 15, 2013 American Academy of Family Physicians’ blog cautions that PAs and NPs may not be able to address the physician shortage to the degree some hope.  The reason is simple; a number of PAs and NPs do not work within the primary care setting.

At this point, there is no clear answer to the growing physician shortage.  We will need to try a combination of initiatives.  But even with a multifaceted approach, we will probably not be able to escape the fact a shortage will continue to be a growing problem.