As the Affordable Care Act approaches its second year of existence, there’s an important question that needs to be asked: are there enough doctors to be able to treat those who have been newly insured? For many Americans, the answer to that question is a resounding no.
Nearly 20% of Americans live in a community that has an insufficient number of primary care doctors which are available to them.
Primary Care Physician
All areas of medical care are facing shortages. 16% of Americans don’t have access to proper dental care because of a shortage of dentists. There are even deeper shortages in the areas of mental health. Unless immediate changes are made, the US is projecting a total shortage of 45,000 primary care physicians by the year 2020.
Are The Shortages Even Greater Than This?
- Many of the current primary care doctors that are currently practicing do not accept any Medicaid patients because the compensation rates are low – and many insured in the ACA are on Medicaid.
- With up to 36 million newly insured, wait times to get into a medical provider can be as long as 6 months in some areas for routine appointments, like a well child exam.
- The federal government estimates the physician supply will increase by 8% in the next decade, but the number of Americans above the age of 65 will increase by 36% in the same time period.
- Primary care is a less appealing path of practicing medicine because specialty fields can increase income potentials by more than $3 million.
- Aging and population growth are projected to account for 81% of the change in demand between 2010 and 2020.
- Even if nurse practitioners and physician assistants were fully utilized to supplement the existing need for patients, there would still be a shortfall of over 6,000 primary care physicians in the United States in 2020 more than there is today.
- Researchers estimate that America’s current primary care workforce would need to expand by 3% between 2010 and 2025 to keep up with the country’s health care demands.
With big changes come big challenges. That has definitely been the case with the law that has been dubbed “Obamacare.” Some regions have seem dramatic increases in care, while others have seen dramatic decreases. In Jefferson County, WA for example, the primary care wait times have increased from 30 days to 180 days for routine procedures. This has led to an increase in walk-in and urgent care patients, which may not be covered as adequately by a household’s insurance plans as a visit to the primary care physician. Then there’s the fact that there is no established relationship with that doctor. There was already a shortfall of primary care physicians. The Affordable Care Act simply expanded the existing problem to greater heights.
Why is There Such A Shortfall of Doctor Care?
- The Affordable Care Act added 34 million Americans to insurance rolls that weren’t there before.
- Most physicians don’t spend 100% of their time seeing patients.
- There is a certain distribution issue amongst the nation’s doctors, which could also account for some of the regional shortfalls that are being seen.
- In 2008 data, Americans made 977 million office visits in 2008. Of those, 462 million visits were to primary care physicians.
- Older patients tend to see their primary care physicians more often than younger patients and those with insurance seek more doctor care than those without insurance.
- Although the insurance expansion has created more demand, that demand is expected to ease by 2015. It’s the aging population that is expected to account for the majority of shortfall issues in 2016 and beyond.
Right now we’re in the middle of a bad stretch in the American health care field. With an 18% GDP and long wait times, the growing pains are almost unbearable in some locations. Primary care physicians are needed now more than ever before, but that isn’t an easy fix. Getting graduates into residency programs and new students into educational programs will help, but the education process takes time. New doctors can’t just be created overnight. The United States is going to continue to have issues until more people can be trained in the field of medicine.
What Is Being Done To Solve The Problem?
- $75 million has been allocated to train physician assistants and nurse practitioners.
- $11 billion was set aside to invest in community health centers during the next 5 years throughout the United States.
- The government made a one-time investment of $168 million to help increase the number of medical school graduates entering primary care residency programs.
- The amount of new physicians that these investments are expected to be able to create under the current educational system: 500 doctors per year.
- This accounts for about a 10% increase over the current numbers of students that enter the field every year.
- After graduation, the median annual stipend for residents and fellows is around $55,750, yet 79% of medical school graduates acquired education debts of over $100,000.
- The average medical school debt in 2012: $166,750.
- The average family doctor sees 85 patients per week, the highest of any practicing doctor, and works an average of 49 hours per week.
- Only 28% of family doctors say that they would choose that field of medicine again if they had a chance to do things over.
It’s time to just admit that the entire health care system is broken in the United States. A majority of doctors regret choosing the field of practice that they are working in. 52% of doctors in the United States wouldn’t even choose a career in the field of medicine if they could do things over. With average salaries all in triple figures, that says something about the state of modern US health care. Some of those issues are going to be fixed over time. To assume that the ACA has fixed everything, however, is naïve. We need to invest into doctors, patients, hospitals, and new treatment options that will make the system more efficient and cost-effective. Until we do that, expect a wait time of 6 months or more.