Dr. Kevin Pho, an internist in Nashua, NH and blogger at KevinMD.com, has an opinion piece published at CNN of all places (CNN?!!) adding to information that I've previously noted. His point in this piece is that a physician shortage, which is already present in some specialties, particularly in some geographic areas (due to a state's tort laws), will likely be exacerbated in internal medicine by the proposed health reform. For evidence he has a look at the state to his (and my) south.
Today, 97 percent of Massachusetts residents have health insurance, the highest in the country. But less publicized are the unintended consequences that the influx of half a million newly insured patients has had on an unprepared primary care system.
The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to 50 days, with almost half of internal medicine physicians closing their doors entirely to new patients. And when you consider that Massachusetts already has the highest concentration of doctors nationwide, wait times will likely be worse in other, less physician-abundant parts of the country, should universal coverage be enacted federally...
Massachusetts is finding out just how difficult it is to fiscally maintain universal coverage. In part due to soaring health costs, the state Legislature has proposed reducing health benefits for 30,000 legal immigrants and cutting funding to inner-city hospitals like Boston Medical Center, which, according to the Boston Globe, may "force it to slash programs and jeopardize care for thousands of poverty-stricken families."
It's important to remember that the pipeline of physicians is like a huge submarine. It doesn't turn on a dime. And so if there is a sudden and dramatic increase in patient volume or an increased need in a certain specialty it will take a minimum of 10 years to begin to fill the deficit. Dr. Pho credits the draw of "more lucrative" specialty practice for nurse practitioners, physician assistants and MD's for worsening the shortage, but many of those "more lucrative" specialties have or anticipate their own shortages.
It's said that the definition of insanity is to repeatedly perform the same action and expect a different result. President Obama can have a look at Massachusetts, and also Maine. Maybe he thinks that if the federal government takes control of the situation for the entire nation the physicians, hospitals and other providers will be forced to accept the dictates handed down. Perhaps, but then we're back to the underlying question. Where will the needed physicians come from?
