One of the side effects of providing 32 million additional Americans with health insurance is that many of these people are going to actually use it to see a doctor. And the first place most will bring their shiny new insurance card will be to see their primary care-physician, if they have one.
Nationwide, the 30 percent of the physician work force that currently provides primary care was already struggling to keep up with patient demand long before the health reform. And plans to bring more doctors to this lower-paying, perhaps less prestigious corner of medicine are not going to come through in time to meet the needs of the 10 to 20 percent increase in primary-care visits experts predict will follow the legislation.
As a model for where this scenario may be headed, many experts point to Massachusetts, where demand for PCP services rose dramatically after the state enacted near-universal health coverage in 2006. In the immediate aftermath, the percent of internists accepting new patients dropped to 51 percent in 2007, down from 66 percent in 2005. More recent studies indicate that the wait to see a doctor in the Bay State can be as long as 100 days, with the average being about 49 days (a wait time followed distantly by Philadelphia, at 27 days).
Nonetheless, provisions in the new law intended to help address the PCP shortage include increased student loan forgiveness programs, scholarships and bonuses for medical graduates who choose to go into primary care. The legislation also calls for the creation of a new committee to study the changing landscape of primary care, according to an article on CNBC.com.
The bill also includes money for community clinics and a 10 percent increase in Medicare reimbursements to PCPs. "That comes to about $2,000 a year," Russell G. Robertson, chairman of the family and community medicine department at the Feinberg School of Medicine at Northwestern, told The New York Times. "It won't move the needle."