A quick glance at today’s story in The New York Times on the expanding shortage of physicians might leave the impression that the Affordable Care Act is to blame. Starting with an accurate, if somewhat misleading, headline — “Doctor Shortage Likely to Worsen With Health Law” — it then goes on to explain the dynamics of the growing shortage.
The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.
Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.
A close read — and a quick glance at the paper’s chart — makes it clear that we are looking at a one-time bump in need and that the issue at hand is not the health law but the health system itself. There is a dangerous shortage of doctors now, especially primary care physicians, and any stress put on this shortage is due only to the need to cover more uninsured Americans.
So, what are the issues? First, there is the confluence of population growth and the aging of the population.
Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.
“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”
The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.
Just as significantly, the Times reports, compensation remains a problem, encouraging med students to pursue the glamour specialties (I.e., plastic surgery) at the expense of primary care and general medicine.
The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.
The health-care system in the United States is broken. Its incentives have nothing to do with care and remain based on profit and money. The cost of becoming a doctor is enormous; recouping that money means chasing the big payday offered by the specialties, a recipe for poor care.
Tinkering around the edges, as the ACA does, is not a solution, but it aloso is not the problem.
We need systemic change in the form of single-payer.
Hank Kalet 