The coming primary-care physician shortage under ObamaCare

posted at 2:55 pm on April 5, 2010 by Ed Morrissey

What happens when you take an existing system of care that already features long wait times and a declining number of providers — and add millions more to the plan?  The Business Courier of Cincinnati looks at the Medicaid expansion of ObamaCare and concludes that rather than improving access, the system will get strained to the breaking point — especially with the government encouraging a higher rate of access for preventive medicine:

The 32 million people who will become insured under the new health care reform act will place a major strain on the country’s health care system, including in the Tri-State, experts say.

“There are simply not enough primary-care providers available to take care of all these newly insured individuals,” said Dr. Peter Kambelos, an internal medicine physician who practices in Monfort Heights. …

Greater Cincinnati has a shortage of 595 primary-care physicians, according to December data from the Cincinnati MD Resource Center, a free physician recruiting service formed by the nonprofit Health Improvement Collaborative of Greater Cincinnati. The area’s 234 primary-care doctors per 100,000 residents compares to an “optimal” number of 261 per 100,000 that U.S. Department of Health and Human Services data would suggest.

The American Academy of Family Physicians has warned of an impending national shortage of 40,000 such physicians by 2020. About 140,000 will be needed in all to meet the needs of the aging population, the group has said, but current trends suggest there will be only about 100,000.The U.S. Census Bureau puts the current number of uninsured at 45 million.

“People can have all the insurance they want, but if they can’t get in to see anyone, it’s not going to do anyone much good,” Kambelos said.

That also prompts another question about the Medicaid system and the flight of providers.  If there aren’t enough providers willing to see patients, doesn’t that mean that nothing much has changed for the 32 million about to hit the rolls of the program?  The entire purpose of this expansion and massive government intrusion in the health-care system is to get patients out of emergency rooms and into clinics.  If patients have to wait months or years to get into a diminishing number of clinics, where will they end up?  In emergency rooms.

As noted last week, the Obama administration answer to this is to establish “medical homes” where patients get health care provided by people other than doctors: nurses, physician assistants, and others.  Kambelos isn’t impressed with the idea of recycling HMOs:

Kambelos doubts the medical home model is the answer to many of the health care system’s problems. He dislikes its focus on “physician extenders” such as nurses and assistants when, in his opinion, getting more doctors into primary care should be the focus. And he doubts that will happen until the government and private insurers commit to significantly closing the gap between reimbursement levels.

“As long as medical students look at primary-care salaries as noncompetitive and not consistent with the lifestyles they want to lead,” Kambelos said, “the supply is not going to be there.”

Kambelos puts his finger more on a symptom of the problem rather than the problem itself.  Reimbursement rates aren’t so much the problem as the reimbursement system itself — especially for standard health-care delivery.  The third-party payer system interferes with the normal pricing mechanism that allows supply to meet demand and on-time delivery.  The more that primary-care business depends on arbitrary reimbursement rates at all, the less likely that doctors will choose to meet that demand, instead selecting other disciplines where their services get compensated more honestly and appropriately.

We’re about to make the problem worse by creating an even greater artificial shortage of providers than we currently have.  That won’t help the people that ObamaCare purports to serve, and will only make it worse for the rest of us.

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April 04
Liberty in Action: First Private Lawsuit Challenging ObamaCare Filed in Mississippi
by K. Douglas Lee

Excellent article.

GrannyDee on April 5, 2010 at 5:44 PM

all according to the marxist plan

notagool on April 5, 2010 at 5:48 PM

Bob stands up in front of patient group.
“Hi. I’m Bob, and I have a heart murmur.”

GROUP: “Hi Bob”

Scouter on April 5, 2010 at 5:53 PM

Bob stands up in front of patient group.
“Hi. I’m Bob, and I have a heart murmur.”

GROUP: “Hi Bob”

Scouter on April 5, 2010 at 5:53 PM

Ding, ding, ding. We have a winner! (And you owe me a monitor.)

GrannyDee on April 5, 2010 at 6:09 PM

It won’t be too long before a Union of Providers for Your Obamacare’s Universally Retarded Shit pops up (UPYOURS).

The shit will really hit the fan when UPYOURS starts asking for prevailing wages and other benefits on all government provided care like unions are provided for all other government work. Like retiring at 50 with nearly full pay is really going be the solution to getting more providers…

drfredc on April 5, 2010 at 6:28 PM

These “Medical Homes” where patients would get care from nurses, physicians assistants, etc…? Something to consider is the fact that a lot of students currently taking classes towards degrees that were going to put them into those types of careers (my daughter for example is in her freshman year and was to apply to the nursing school at her university) are now reconsidering their options.
Not only will there not be enough doctors, there won’t be enough nurses, physicians assistants, etc….
These kids are taking a serious look at this bill and making new career plans.

serpentineshel on April 5, 2010 at 7:52 PM

Would this story be a good example of what is in store for us – lawsuits against the States/Feds because of the change in wording from medicaid medical coverage to medical care ?

$29.1 million dollar settlement against the Fed government (smaller one against the hospital) because the clinic was federally funded.

journeyintothewhirlwind on April 5, 2010 at 8:29 PM

One word:

Indian Reservations

Remember that you heard it here from good ol’ justie.
Ah, if I were only younger and a smart businessman.

justltl on April 5, 2010 at 8:35 PM

I would set up the clinic to end all clinics on one or more Indian reservations.

Fee for service.
No third party payers.
No malpractice bullshit.
Recruit the finest of the finest docs to practice medicine like they wanted to when they went into the field.
Hold these docs and hospitals/clinics to the highest of standards (a challenge to which any good doc worth his salt would rise and, in fact, savor).

When one of you medico-business types does this, please call it the Justie Clinic.

Thank you.
I appreciate it.

justltl on April 5, 2010 at 8:41 PM

Good God, man!
You’re a genius!
Not to mention highly under-appreciated by Ms. Allapundit, et al.

Why, thank you!

justltl on April 5, 2010 at 8:54 PM

Ahem- I’d like to buy an “h” for up there in Allahpundit, Pat.

justltl on April 5, 2010 at 8:57 PM

I am on Medicare, my wife isn’t. My blood work cost Medicare $282; her’s with a slightly less analysis request and a lab contract with her insurance company, $17. And we wonder why Medicare is losing money left and right.

amr on April 5, 2010 at 9:30 PM

**Thanks to Romneycare, they are doing group appointments in Massachusetts, too.

flyfisher on April 5, 2010 at 3:07 PM

Uh, no. It is happening in California. Nothing to do with MA’s program. Nice try.

mistythestripper on April 5, 2010 at 10:05 PM

**justltl on April 5, 2010 at 8:41 PM**

Sorry but doctors are already doing as much on their own. It’s called concierge medicine.

mistythestripper on April 5, 2010 at 10:07 PM

mistythestripper on April 5, 2010 at 10:07 PM

Jeepers. I forgot what I was saying.

justltl on April 5, 2010 at 10:13 PM

One word:

Indian Reservations
justltl on April 5, 2010

Thanks for the heads up, Mr. Vice President.

chimney sweep on April 6, 2010 at 3:24 AM

There are so many things wrong with this scheme it’s hard to know where to start, but one thing that keeps running through my head is Obama’s “argument” that “We’ve been trying to do this since Teddy Roosevelt.” The fact that we’ve refused for a century, despite repeated attempts, should tell us something. Progressives blame it all on the rich and business opposition, but I think the Tea Parties have shown that the grass roots opposition is more significant and that places them squarely against the will of the people.

We are a whisker away from European-style socialism. If you want to see where progressives want to take us, consider France, Spain, Germany, Italy and Greece.

flataffect on April 9, 2010 at 2:36 AM