Op-ed: More coverage requires more doctors

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New Hampshire, I’ve been able to observe a universal coverage experiment, similar to what Congress is likely to consider, taking place in the neighboring Massachusetts.

Since that state’s universal coverage law took effect in 2006, its health care system has been inundated with almost half a million new patients. The demand for medical services has rapidly outpaced the supply of care physicians able to provide care.

In its most recent annual survey, the Massachusetts Medical Society found that the average wait time for a new patient to see a primary care doctor averaged 50 days. When you consider that this is a state with the highest density of physicians per capita nationally, it is frightening to think what the wait times would be in other parts of the country should universal coverage be enacted on a federal level.

When patients wait that long to see a physician, they inevitably find their way into the emergency department for care that ordinarily can be handled in an office setting. Doing so increases the cost of managing a routine issue up to ten-fold, and indeed, soaring utilization of emergency care has been an unanticipated consequence since reform was passed. In fact, patients who have obtained state-subsidized insurance visit the emergency department at a rate 14 percent higher than the average Massachusetts resident — evidence that lack of access to doctors is a big problem for newly insured patients.

The lesson here is that universal coverage must go hand in hand with the training of more primary care providers — not only doctors, but also nurse practitioners and physician assistants who can provide excellent primary care. According to the Association of American Medical Colleges, there will be a shortage of 46,000 generalist physicians by 2025, a deficit that not only will balloon under any universal care measure, but cannot be made up as both doctors and mid-level providers gravitate toward more lucrative specialty practices.

So, while any attempt at covering the millions of Americans without health insurance is a laudable goal, doing so without addressing a health care system ill-equipped to deal with millions more patients has the potential to make an already grim situation worse.

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