By Craig Lack, Special for USDR
The Affordable Care Act continues to have many intended and unintended consequences resulting from its phased in implementation. The question of whether there will there be a physician shortage is not as simple as everyone would like. The most correct answer is yes. Yes, but it depends a great deal on where you live and what kind of care you are trying to access.
We need to understand that there are various definitions of a physician shortage. We need to all start from the same position so let’s look at the Affordable Care Act (ACA) in the context of being added to the pre-existing macro economic trends. The shortage was already here and the ACA adds more pressure to the system.
The largest trend related to healthcare in the United States is the aging of the Baby Bookers. Estimates indicate that more than 10,000 citizens per day will turn 65 for the next 16 or so years. The ACA is estimated to add an additional 30 million citizens to the ranks of the insured over the next five to ten years.
So, we can see that between the millions of Baby Boomers heading towards Medicare and the ACA enrolling millions of individuals in the new expanded Medicaid plans and state and federal exchanges, there will be challenges to accessing primary care in a timely fashion. Anyone attempting to deflect the reality of these trends is being political, in a pejorative sense.
Another macro trend is the fact that nearly half of the 830,000 practicing physicians are currently over age 50, 16% are now age 65 or older and more than one third of physicians are expected to retire in the next 15 years. Where will all the new physicians come from that are needed to help the millions of new insured individuals and the millions headed towards Medicare – where medical expenses are absolutely going to happen?
There are more questions. Today, 30% of physicians are primary care and 70% are specialists because that’s where the money has been for the last thirty years. You see, sickness has been the revenue model for the medical treatment system we call healthcare. Like many things in life, the answer is money – what’s the question?
Medical schools are incredibly expensive, residency training can take three to seven years and the entire system has been set up to reward and compensate specialist care. Consequently the ratio of practicing physicians in the United States has changed from 70% primary care physicians and 30% specialists as healthcare has adapted its business model to disease management, prescriptions and chronic disease treatments.
Where you live plays a big role in your physician shortage experience. The government already produces Health Professional Shortage Area maps that indicate the current status of limited access to care. More than 20% of the country already lives in these areas and includes states like Alabama, Louisiana, Mississippi, Arizona, New Mexico and Wyoming.
What does the future of our healthcare system hold?
The major change created by the ACA is the beginning of refocusing healthcare from a disease management to health promotion model and from a quantity of treatment based fee for service compensation business to a quality of treatment outcome based bundled compensation model. Today medical errors are perversely incentivized and outcomes of care have limited financial consequences. Tomorrow we will pay providers to care about the patient both before and after treatment to improve outcomes with lower associated costs and emphasize the prevention of preventable claims.
The industry is slow to change and there are many constituencies that prefer evolutionary change in order to maximize potential profit margins along the way. We will have more internationally trained physicians entering the United States to assist with the shortage. And, as healthcare emphasizes primary care we will see more nurses, nurse practitioners, pharmacists and physicians assistants handling some of the routine preventive care. Many of these expanded roles for non-physicians will be determined on a state by state basis.
What are the key challenges of a physician shortage?
The challenges for the providers are many. The actual practice of medicine is slowly changing as the incentives are realigned to focus more on the patient and the quality of their treatment outcomes. Hospitals will have to change their old school business models of the one-stop shop or become obsolete. Many hospitals will become obsolete and go out of business because they are unwilling and unable to change. The specifics will depend on how many competing hospitals are in a particular city, how big the population and what kind of insurance is paying the bill.
Once again, location will play a large part for physicians. The ebb and flow of physician availability will be impacted by decisions from medical schools, Congress expanding budgets for more training, Medicare revisions and more changes coming from the ACA. On a more personal note, physicians will be influenced by quality of life choices, income needs, debt loads from medical school, entrepreneurial spirit, need for security and location.
Insured individuals, whether covered with Medicaid, group insurance or an individual policy all have to change their coverage, and in many cases, change their physician. As we will witness over the first three years of the ACA, nearly every insured person will have less coverage in the event they get sick as a result of having more ‘skin in the game’.
Many previously uninsured individuals will experience the illusion of the low priced premium insurance policy, especially if they qualify for subsidies, only to discover that getting sick can be very expensive and they will likely not receive care from the provider they anticipated.
Just as there are no one size fits all healthcare solutions, there is no single answer to the problem of a looming doctor shortage. The experience will depend on where you live, what medical care you need and the kind of insurance plan in which you access your medical care.
Craig Lack is a nationally-recognized health care expert, bestselling author, speaker and CEO of ENERGI. He is the creator of Performance Based Health Plans® which Inc. magazine said is “The next big thing.” He has appeared in national media including Fast Company, USA Today, radio and America’s Premier Experts, which aired nationally on the major network affiliates. He’s a member of the National Academy of Bestselling Authors for achieving No. 1 bestseller status on Amazon.