Ian Furst: The looking glass

The following is a reader take by Ian Furst.

Massachusetts’ health care system is a bell-weather for what is to likely to become of health care reform in the United States. The directive for mandatory coverage has driven people that had previously been without a family doctor back into the primary care practices of the state. The result has been a surge in wait times and lack of access to primary care for all those involved.

Family doctors across the state are registering their protests at low pay and long work hours in order to meet the government mandate. The governor has called for suggestions on how to alleviate the problem (without reneging on mandatory coverage) of massive health care costs. Massachusetts need only look north of the border to see that they are only beginning to feel the pinch. In Ontario, Canada lack of access to primary care has been a problem for the past decade. We have instituted a primary care access plan and negotiated a solution with the primary care physicians of Ontario but the numbers still boggle the mind. About 6% of the population in Ontario is without a family doctor, there is a widespread perception that primary care wait times are a problem, and only 10% of primary care doctors in 2007 were accepting new patients. Combine this with Ontario’s expanding, ageing population and the fact that 14.1% of all primary care doctors are over 65 years of age (and 24.4% over 60) and the problem becomes obvious. Currently Ontario has 176 physicians per 100,000 with approximately 84 per 100,000 primary care physicians. No one in the United States would be surprised to hear these kinds of numbers given the structure of our health care system. But when comparing it Massachusetts the problem is small.

Where Ontario has 6% of the population without a primary care doctor Massachusetts is closer to 10%. Where Ontario has 84 primary care physician per 100,000 (and slowly rising) Massachusetts has 82 per 100,000 (and declining in favor of medical specialties). Where Ontario has had a primary care access plan (including enrollment goals, practice expansion and wait time strategies), Massachusetts is only now looking for answers and that is due to fiscal constraints not wait times issues. Now multiply the problems by 52 states and you start to see the magnitude of the primary care crisis. The railroad of primary care need is arriving pending the results of your next Presidential election.

Despite 6 years of hard labor on the part of Ontario’s physicians, nurses, administrators, public servants and sacrifice on the part of the populace our primary care system is saturated with an all time low of 9.7% of primary care doctors accepting patients in the last 2 years. The number of new patients accepted into family practices is nearly equal to that of new physicians (approximately 3% increases). The message should be loud and clear to the people of the United States that health care reform is going to require more than just gaining insurance coverage for those without it. When you compare yourself to Ontario there are a greater number of people needing primary care, fewer primary care physicians and a lack of strategy.

My guess is that without significant movement of money to the primary care side the current trend will continue and people will be left without a family doctor.

Ian Furst is an Oral & Maxillofacial Surgeon and blogs at Wait Time & Delayed Care.

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