Hard to give more HC with fewer, you know, doctors

The coming primary-care physician shortage under ObamaCare by Ed Morrissey of Hot Air

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.

http://hotair.com/archives/2010/04/05/the-coming-primary-care-physician-shortage-under-obamacare/