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Doctor Shortage Likely to
Worsen With Health Law
By Annie Lowrey and Robert
Pear, The New York Times
July 28, 2012
RIVERSIDE, Calif. — In the Inland Empire, an
economically depressed region in Southern California,
President Obama’s health care law is expected to
extend insurance coverage to more than 300,000 people
by 2014. But coverage will not necessarily translate
into care: Local health experts doubt there will be
enough doctors to meet the area’s needs. There are not
enough now.
Other places around the country, including the
Mississippi Delta, Detroit and suburban Phoenix, face
similar problems. The Association of American Medical
Colleges estimates that in 2015 the country will have
62,900 fewer doctors than needed. And that number will
more than double by 2025, as the expansion of
insurance coverage and the aging of baby boomers drive
up demand for care. Even without the health care law,
the shortfall of doctors in 2025 would still exceed
100,000.
Health experts, including many who support the law,
say there is little that the government or the medical
profession will be able to do to close the gap by
2014, when the law begins extending coverage to about
30 million Americans. It typically takes a decade to
train a doctor.
“We have a shortage of every kind of doctor, except
for plastic surgeons and dermatologists,” said Dr. G.
Richard Olds, the dean of the new medical school at
the University of California, Riverside, founded in
part to address the region’s doctor shortage. “We’ll
have a 5,000-physician shortage in 10 years, no matter
what anybody does.”
Experts describe a doctor shortage as an “invisible
problem.” Patients still get care, but the process is
often slow and difficult. In Riverside, it has left
residents driving long distances to doctors,
languishing on waiting lists, overusing emergency
rooms and even forgoing care.
“It results in delayed care and higher levels of
acuity,” said Dustin Corcoran, the chief executive of
the California Medical Association, which represents
35,000 physicians. People “access the health care
system through the emergency department, rather than
establishing a relationship with a primary care
physician who might keep them from getting sicker.”
In the Inland Empire, encompassing the counties of
Riverside and San Bernardino, the shortage of doctors
is already severe. The population of Riverside County
swelled 42 percent in the 2000s, gaining more than
644,000 people. It has continued to grow despite the
collapse of one of the country’s biggest property
bubbles and a jobless rate of 11.8 percent in the
Riverside-San Bernardino-Ontario metro area.
But the growth in the number of physicians has lagged,
in no small part because the area has trouble
attracting doctors, who might make more money and
prefer living in nearby Orange County or Los Angeles.
A government council has recommended that a given
region have 60 to 80 primary care doctors per 100,000
residents, and 85 to 105 specialists. The Inland
Empire has about 40 primary care doctors and 70
specialists per 100,000 residents — the worst shortage
in California, in both cases.
Moreover, across the country, fewer than half of
primary care clinicians were accepting new Medicaid
patients as of 2008, making it hard for the poor to
find care even when they are eligible for Medicaid.
The expansion of Medicaid accounts for more than
one-third of the overall growth in coverage in
President Obama’s health care law.
Providers say they are bracing for the surge of the
newly insured into an already strained system.
Temetry Lindsey, the chief executive of Inland
Behavioral & Health Services, which provides
medical care to about 12,000 area residents, many of
them low income, said she was speeding
patient-processing systems, packing doctors’ schedules
tighter and seeking to hire more physicians.
“We know we are going to be overrun at some point,”
Ms. Lindsey said, estimating that the clinics would
see new demand from 10,000 to 25,000 residents by
2014. She added that hiring new doctors had proved a
struggle, in part because of the “stigma” of working
in this part of California.
Across the country, a factor increasing demand, along
with expansion of coverage in the law and simple
population growth, is the aging of the baby boom
generation. Medicare officials predict that enrollment
will surge to 73.2 million in 2025, up 44 percent from
50.7 million this year.
“Older Americans require significantly more health
care,” said Dr. Darrell G. Kirch, the president of the
Association of American Medical Colleges. “Older
individuals are more likely to have multiple chronic
conditions, requiring more intensive, coordinated
care.”
The pool of doctors has not kept pace, and will not,
health experts said. Medical school enrollment is
increasing, but not as fast as the population. The
number of training positions for medical school
graduates is lagging. Younger doctors are on average
working fewer hours than their predecessors. And about
a third of the country’s doctors are 55 or older, and
nearing retirement.
Physician compensation is also an issue. The
proportion of medical students choosing to enter
primary care has declined in the past 15 years, as
average earnings for primary care doctors and
specialists, like orthopedic surgeons and
radiologists, have diverged. A study by the Medical
Group Management Association found that in 2010,
primary care doctors made about $200,000 a year.
Specialists often made twice as much.
The Obama administration has sought to ease the
shortage. The health care law increases Medicaid’s
primary care payment rates in 2013 and 2014. It also
includes money to train new primary care doctors,
reward them for working in underserved communities and
strengthen community health centers.
But the provisions within the law are expected to
increase the number of primary care doctors by perhaps
3,000 in the coming decade. Communities around the
country need about 45,000.
Many health experts in California said that while they
welcomed the expansion of coverage, they expected that
the state simply would not be ready for the new
demand. “It’s going to be necessary to use the
resources that we have smarter” in light of the doctor
shortages, said Dr. Mark D. Smith, who heads the
California HealthCare Foundation, a nonprofit group.
Dr. Smith said building more walk-in clinics, allowing
nurses to provide more care and encouraging doctors to
work in teams would all be part of the answer. Mr.
Corcoran of the California Medical Association also
said the state would need to stop cutting Medicaid
payment rates; instead, it needed to increase them to
make seeing those patients economically feasible for
doctors.
More doctors might be part of the answer as well. The
U.C. Riverside medical school is hoping to enroll its
first students in August 2013, and is planning a
number of policies to encourage its graduates to stay
in the area and practice primary care.
But Dr. Olds said changing how doctors provided care
would be more important than minting new doctors. “I’m
only adding 22 new students to this equation,” he
said. “That’s not enough to put a dent in a
5,000-doctor shortage.”
Annie Lowrey reported from Riverside, and Robert Pear
from Washington.
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