BY: ANAND TAYAL, CONTRIBUTOR
Patients across the country will see an insurmountable shortage of doctors in primary care. According to the Health Resources and Services Administration, the federal agency charged with improving access to health care, nearly 20 percent of Americans live in areas with an insufficient number of primary care doctors. Sixteen percent live in areas with too few dentists and a whopping 30 percent are in areas that are short of mental health providers. Under federal guidelines, there should be no more than 3,500 people for each primary care provider; no more than 5,000 people for each dental provider; and no more than 30,000 people for each mental health provider.
Additionally, the Association of American Medical Colleges (AAMC) finds there will be a shortage of 45,000 primary care doctors in the United States (as well as a shortfall of 46,000 specialists) by 2020. The physician shortage especially in primary care can be attributed to many factors, specifically money and a poor work to life ratio. During the course of their careers, primary care physicians earn around $3 million less than their colleagues in specialty fields, which makes primary care a less appealing path for many medical students. Finally, a career in primary care has received a steady stream of negative attention, making medicine a far less attractive career choice than it once was, according to Rosenberg of the National Council for Behavioral Health. Insurance headaches, pricey technologies, long hours and the risk of liability have convinced many talented students to eschew medicine as a career choice.
The primary care physician shortage coupled with an influx of newly health insured Americans and an aging population could potentially crash the United States health care system. Millions of Americans will be forced to compete for attention from primary care doctors and wait longer for primary care appointments. The goal of primary care is to find and treat the disease as soon as possible, unlike the emergency room which is geared to stabilize an condition. Preventative care helps limit the number of uneccesary and costly trips to an emergency room. The National Association of Community Health Center finds that at least one-third of all ED visits are “avoidable”, meaning, non-urgent or ambulatory care sensitive (ACS) and therefore treatable in primary care settings, and that over $18 billion dollars are wasted annually for avoidable ER visits.
The negative effects of the physician shortage can be found in a study done in Massachusetts. The Massachusetts Medical Society found that wait times to get an appointment at primary care physicians’ offices increased significantly when the ACA was enacted, and they’ve remained high ever since. A Harvard study found all 11 of the emergency rooms that researchers studied in Massachusetts became busier after the law went into effect. The problem is exacerbated further as About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published in the journal Health Affairs. Essentially, the estimated 50 million Americans receiving the benefits of Medicare will have an even more difficult time finding a primary care physician.
The Affordable Care Act, while increasing shortages in the short-term, allocates an additional $1.5 billion in funding for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a shortage. The law also puts more money toward training in hopes of increasing the primary care workforce. It offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015. The law’s emphasis on coverage for preventive care may also mean fewer people will need to visit doctors for more serious issues down the road. This program will hopefully mitigate the short-term strains the health care exchanges place on the system.
Conceptually, an adequate immigration reform would solve for much of the physician shortage problem. Granting more H-1B visas to international medical graduates who have already completed U.S. residencies in high-demand specialties, including primary care, and who agree to practice for a prescribed length of time in underserved areas, would meet a pressing national need while ensuring that these physicians augment their prior medical training with additional training and practice in America. The mutually beneficial relationship, granting more opportunities to foreigners while improving our system domestically. However, any attempt at immigration reform has been blocked by the House of Representatives. Recently, in March Speaker of the House John Boehner shut down the Immigration Reform bill proposed by the bipartisan committee led by Sen. Marco Rubio. The Immigration Reform bill would have helped immigrants who had obtained H-1B visas to work and train in the United States.
Americans should ideally have access to a doctor, but the ongoing physician shortage partially caused by the well-intentioned ACA actually makes receiving the most optimal healthcare incredibly difficult for many individuals. Many Americans who are receiving new insurance through healthcare.gov or are already receiving Medicare will especially find difficulties in receiving something as fundamental as primary care. Solutions exist in potential immigration reform and the Affordable Care Act, but Congress must be able to act on both of these legislations for either of their benefits to come to fruition. The United States health care system is in jeopardy and swift comprehensive action (both of which Congress lacks) is needed to solve for the negative effects posed by the physician shortage.