December 10, 2014

Are We Really Facing a Shortage of Doctors?

At least this is slightly a more balanced approach with both sides having realistic projections. I will only say that I agree that there will be a doctor shortage, but maybe not primary care doctors, as least as big as is being projected.

The shortage will be severe in geriatric doctors. These are the doctors that will be needed to care for the baby boomers that are increasing every day. Geriatric means, pertaining to elderly persons or the aging process. Primary care doctors are not qualified to handle geriatric medicine, especially those with multiple diseases or chronic conditions. Some will be needed for those with single conditions, but geriatric doctors should be in charge of these patients. Read this article in WebMD as they present their points.

Many medical groups, led by the Association of American Medical Colleges say they think the shortage will be close to 130,000 in the next 10 to 12 years. It is the health care economists that are less convinced. They say that concerns that the nation faces a looming physician shortage, particularly in the primary care specialties, are common. An expert panel of the Institute of Medicine (IOM) wrote in a report that the committee did not find credible supporting evidence of a severe physician shortage.

As many as 10,000 baby boomers are becoming eligible for Medicare every day. And older people tend to have more medical needs. Everyone thinks that the Affordable Care Act (ACA) is creating millions of patients, but they may soon see that the ACA is driving millions of patients away from coverage and doctors. There are more of these predictions every day and one radio program that I listen to sporadically has callers that are complaining about not being able to afford the new Obamacare insurance with the high premiums and high deductibles.

I can agree there will be a mismatch but maybe not in the doctors needed, but in the location of these doctors. New doctors seem to cluster in the northeastern part of our country and in or near the larger cities. The medical associations or doctor organizations are crying for more primary care physicians, but they are crying for the wrong doctors. Doctors of geriatrics will be needed for the aging population and not primary care doctors. Yet, the medical associations don't see it that way.

Many primary care doctors cannot take care of complex elder patients and handle the combinations of chronic conditions they are likely to have. Some of the larger medical practices may have doctors or specialists to care for them, but most in smaller and rural communities will be ill trained and equipped to handle these patients.

In some geographical locations, many services can be provided by primary care doctors, but in other locations, physician assistants, nurse practitioners, and even pharmacists and social workers will need to be included in the mix. .

Currently, physicians who are specialists make considerably more than those who practice primary care, which many experts say is a huge deterrent to doctors becoming generalists, particularly when they have large medical school loans to pay off. However, “team-based care,” where a physician oversees a group of health professionals, is considered by many to be not only more cost-effective, but also a way to lower the number of doctors the nation needs to train.

What may happen in the future is unclear with doctors and economists making their predictions. Some areas of the country will be well served and the seniors well taken care of medically. It is the rural areas that I am concerned about where there will be single practitioners serving the Medicare patients. Traveling over 150 miles to see a doctor may not be possible. Until telemedicine is authorized and the rural states have internet connections for everyone, seniors may actually be in danger of being harmed.

No comments: