While we in the trenches wait for the courts and Congress to sort out the new health care reform laws, a much bigger crisis is leaning toward a tipping point. Having health insurance of any kind may not ensure that you can get health care – at least not in a timely manner. What we have here is failure to replace our retiring physicians in sufficient quantities to meet the needs of an aging population – about 72 million seniors by 2020, or twice the number we have now. And that doesn’t factor in the estimated 32 million more people who will be admitted to our health care system thanks to ObamaCare let alone the estimated 32 million more people ObamaCare admits to the system. Very soon, all of us may be facing the inadequate supply of health care providers that people living in rural and remote areas already experience.
For many health insurance plans, especially HMOs, a primary care physician is a requirement. You cannot see a specialist unless you go through this gatekeeper. But as the number of gatekeepers dwindles, the gates will become rapidly clogged, creating long waits. If you’re in a PPO, the problem may not be as immediately acute, but sooner or later, with only so many general practitioners and internists to go around, you’ll be taking a number and waiting in line, too. Or maybe, as some suggest, you can see a nurse practitioner for routine medical care.
What created this crisis? According to a report in Newsweek (2.26.10), the number of U.S. medical students who pursue a career in primary care each year has dropped more than half since 1997. You can’t really blame them when you do the math. Med school grads leave with a degree and about $200,000 in debt. Primary care docs earn less than half the annual income of specialists. Congress didn’t help matters, when in 1996, it capped the number of new doctors Medicare would pay to train. That put a big strain on America’s teaching hospitals, who depend on Medicare funding to pay a big chunk of doctor training. As of today, we train about 16,000 new doctors a year, according to an editorial by Dr. Herbert Pardes in the Wall Street Journal (1.18.11). Pardes claims that to keep up with the growing demand for general practitioners and specialists, we need to bump that up by 6,000 to 8,000 more per year for the next 20 years!
At the end of the day, the best health insurance coverage in the world won’t be much use if you can’t find a doctor.