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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  • http://www.myrosevillechiropractor.com Jared Thomas

    Scary to imagine what it will look like in California! Just out of curiosity, what would you think about utilizing chiropractors as primary care physicians? I had this thought and wrote about the arguments for it in my blog if you are interested.

  • http://www.drcpainmd.com Sarah for Brad Carpentier, M.D.

    You should know about Stop Practicing Medicine, a new political action group aimed at insurance companies who want to get in the way of diagnosis:

    Stop Practicing Medicine is a political action group started by Bradley Carpentier, M.D., in response to insurance companies who use non-specialists to try and practice pain treatment. Medicine is a sacred trust between a doctor and a patient. Stop Practicing Medicine asks insurance companies to allow doctors to practice medicine without their interference.

    Stop Practicing Medicine is made up of serious physicians with a history of outstanding service to patients. They are motivated by a concern that insurance companies sometimes deny patients their right to quality medical care, a right to good health and at times, a right to life. It is premised by the belief that every human being has the right to thrive and that any decision based solely on profit is not in the best interest of the patient and his or her community.

    The belief that medicine is best practiced by qualified physicians, specializing in a particular field of study has been sound for centuries. Many insurance companies employ a professional to make random medical decisions that can affect a patient’s health, livelihood and emotional well being. Often these insurance-company decisions are not carefully made; rather they are motivated by profit only. The decisions are often made under the guise of quality medical care, or evidence based medicine, but the intention of these guidelines is manipulated to suit the insurance carrier purpose of limiting costs and effectively denying care.

    Stop Practicing Medicine will utilize the support of colleagues, patients and their families to speak out against the injustice of interference in medicine.

  • http://sideeffectsmayinclude.wordpress.com whitny

    I essentially agree with what you are saying about addressing the shortage of providers, but I don’t understand why newly-insured patients with lack of access are so much worse on “the system” than uninsured patients with lack of access. These people had no option but to go untreated or seek emergency services before they acquired medical insurance, and it seems like a 50-day wait to see a PCP is an improvement over no PCP at all. You say the system was inundated with half a million “new” patients since 2006, but these patients were probably accessing the health care system in more expensive and less effective ways before they were insured. We can’t leave people uninsured for the convenience of not having to count them. Furthermore, people with state-subsidized insurance may be accessing emergency services at a higher rate than average due to lack of access, but maybe also for other reasons related to demographic variables or other variables associated with being someone with state-subsized insurance. How do the rates of accessing emergency services compare between those with state-subsidized insurance and no insurance?

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