Solutions to the Looming Doctor Shortage
And why health care reform could make it worse
The health care fight has touched on everything from death panels to socialism, but columnists are worried there's a far more immediate concern: a doctor shortage. Experts say there are hundreds of thousands fewer primary care physicians than the country needs. And if reform passes, they say it will only worsen the dearth. So while more Americans will have the ability to pay for health care, they may struggle to find a physician. Some worry that the problem, which is now especially acute in rural areas, could become a national crisis after the health care overhaul. A look at the doctor shortage:
- Not Enough Small Town Doctors The Washington Post's Philip Rucker says small town medicine doesn't pay off medical school debt, so "young doctors saddled with medical school debt are more often drawn to such lucrative specialties as radiology or anesthesiology in big cities or suburban areas, where they can earn double the $120,000 to $140,000 salary of a rural family practitioner." Profiling Ben Edwards, the only doctor in a small Texas town, Rucker reports that it will be impossible for him to treat the new patients that will come with reform. "The system's going to be overwhelmed when everybody's insured," Edwards says. "We're putting the cart before the horse. You've got your little insurance card and there's no doctor to show it to."
- Primary Care Physicians Are Underpaid In April, The New York Times's Robert Pear reported that creating incentives for encouraging more doctors to go into family practice would be difficult.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors -- a difficult argument at a time of huge budget deficits.
- Government May Have to Subsidize Medical School In The National Journal, Jason Plautz says Congress is considering helping to ease the burden of loans for doctors who choose to practice family medicine, who earn far less money than specialists. "The bill passed by the Senate Health, Education, Labor, and Pensions Committee would make it easier for students entering primary care to get loans and would repay some of their debt in exchange for working in a public health program for more than three years."
- We Must Invest in Rural America At the Moderate Voice, Jerry Remmers says addressing the doctor shortage is fundamental to reform. "It is not a question of public options or stringent rules on health insurers denying coverage for preexisting conditions," he writes. "It is a system that makes it economically awkward to entice family doctors to practice medicine in rural America. The rural hospitals can treat broken limbs but rarely can afford the expensive diagnoses equipment to treat respiratory, heart, kidney and other diseases."
- Wanted: 25,000-50,000 New Doctors At the Frum Forum, Stanley Goldfarb says the health care overhaul is going to make the shortage worse. "If the argument for a wholesale revamping of American healthcare depends on the large number of uninsured, typically estimated at 45 million (although a New York Times editorial elevated the number of medically uninsured and underinsured to over 100 million), then there had better be some plan that goes along with the reform to find the 25,000 to 50,000 new physicians that will be required."
- How to Grow More Doctors At The Wall Street Journal, Herbert Pardes says "Congress needs to think about how to increase doctor pay, institute malpractice reform, and provide subsidies to reduce the amount of debt doctors have to take on. Residency caps should also be raised so teaching hospitals can train more doctors."
You Cannot Replace Doctors At Forbes, Dr. Marc Siegel says proposals to address the shortage with nurses and physicians assistants fall short. "I believe nurse practitioners are useful, but I also believe my four years of medical school and three years of residency count for something. If primary care doctors become extinct, so will the kind of care our patients are used to receiving."