By Louis J. Goodman, PhD, President, The Physicians Foundation and
Timothy B. Norbeck, Executive Director, The Physicians Foundation

Now that the health care bill has passed and the smoke has cleared from the acrimonious debate—if only for a little while—it seems appropriate to reflect on what has happened and how this significant legislation will impact our health care system.

We don’t know of anyone who would oppose, on moral grounds, insuring everyone, and that includes us at the Physicians Foundation (PF). Some have argued, however, that the overall cost of the legislation may be prohibitive. While that argument goes beyond our expertise, we do believe that there is an important and relevant issue that has been ignored in this debate. 

Many groups and think tanks seem to agree that there is a present shortage of practicing physicians in the United States, especially those in primary care. These same entities, including the Association of American Medical Colleges (AAMC), point to what they envision as serious shortages amounting to as many as 100,000 physicians over the next ten or fifteen years.

The Physicians Foundation is a 501(c)(3) organization created in 2003 to help physicians, in an increasingly difficult practice environment, to continue delivering high quality health care to their patients. The physician shortage is a huge concern to us—and its effect on patients and physicians alike.

In 2008, the PF, in collaboration with Merritt Hawkins & Associates, undertook a comprehensive survey of all primary care physicians in the U.S. The results were rather dramatic and considerably distressing about the difficulties they are encountering in sustaining their medical practices.  What was also very telling and relevant to the discussion on the physician work force were the following:
         
• 63% said that increasing paperwork has caused them to spend less time per patient, and
• 76% said they were either at “full capacity” or are “overextended and overwhelmed,” and
• Less than 6% of physicians assessed their colleagues’ morale as positive and 78% reported that over the past five years the practice of medicine has become less satisfying.

Because of these factors, 49% of physicians reported over the next one to three years their intention to reduce the number of patients they see or to stop seeing patients entirely due to retirement, working part-time or by seeking non-medical jobs.

The entire survey may be found on the PF website (www.physiciansfoundation.org). It is also available in a new book entitled: In Their Own Words, published by Morgan James. In it, physicians explain that the difficulty working with managed care organizations, liability insurance/ defensive medicine, non-clinical paperwork, increasing demands on their time, onerous government rules and regulations, declining reimbursements at a time when their practice costs are escalating and a shortage of primary care physicians are growing impediments to the delivery of patient care in their practice environment.  In view of the influx of 30 million more insured patients into our health care system, the above findings are sobering to say the least! How will there be enough doctors available to take care of everyone?

For the past 25 years, the number of physicians completing training in the U.S. has remained flat at about 24,000 per year. During that time, a handful of new medical schools have been added, and enrollment is gradually increasing. AAMC has initiated a plan to grow medical school enrollment by 30% by 2015, but that won’t help unless the number of medical residencies available for them, now fixed by law, is increased as well.

To its credit, Massachusetts attempted to insure all of its residents in 2006. According to the Massachusetts Medical Society (MMS), the Bay State is now suffering a “critical shortage” of primary care physicians.” Not surprising to anyone, however, is that expanded insurance coverage for everyone—regardless of its noble objective—has caused an increase in demand for medical services. But there hasn’t been a corresponding increase in the number of doctors to treat them. Many Massachusetts residents now have the insurance coverage but can’t find a physician. The MMS also found in its 2009 survey that 56% of Massachusetts physicians in internal medicine are not accepting new patients. And new patients who are fortunate enough to secure an appointment with a primary care doctor have an average waiting time of 44 days!

It is obvious that the U.S. physician work force and medical residencies available must be increased—and rather quickly---in order for physicians to cope successfully with 30 million new patients. Washington heretofore has basically ignored an issue that will greatly impact patient care and which must be addressed now. As noted in Shakespeare’s “Henry Vl”, “Delays have dangerous ends.”