Even now that health insurance exchanges mandated by the Affordable Care Act are now open for business, office-based physicians, particularly in primary care, aren't sure how the full rollout of the law will affect their practices.
Tom Shaffrey, M.D., a New-Jersey-based primary care physician, for example, told the Philadelphia Inquirer that he's worried that some of his current patients may no longer be covered to see him under narrower provider networks associated with new plans under the ACA.
"We have no way to know exactly how this is going to play out, but the indication is that our members will be dropped, will be excluded from seeing patients that they may have known for a majority of their lives," said Shaffrey, president of the New Jersey Academy of Family Physicians. "I think it is going to have a tremendous impact."
Physicians also voiced concerns in USA Today about longer wait times to get appointments, less face time with patients, rising costs and more burdensome paperwork. "When you get past everybody's particular political opinions about the ACA, really the question does boil down to one of volume and access," said Christopher Goodman, M.D., a Columbia, S.C., internist. "And the burden falls more on primary care, internal medicine and family medicine."
If the experience in Massachusetts is any indication of what the rest of the country can expect, physicians may have reason to be positive. According to Stuart Guterman, a vice president at the Commonwealth Fund, a nonpartisan health policy think tank in Washington, D.C., wait times to see physicians did increase since the state's health insurance mandate began in 2006, but there was no evidence that the increase resulted in worse outcomes.
And although the predicted shortfall of physicians is severe, practices likely won't see all newly insured patients flooding through the door at once, noted Albert Osbahr, M.D., a family physician in North Carolina and an American Medical Association board member. Practices can use this ramp-up time to prepare for higher volumes and tighten their efficiencies.
"I don't think physicians want to lose quality time with patients," Osbahr told USA Today. "We are going through the growing pains of making change. And we're hoping the inefficiencies of transition will slowly work their way out."