A waiting room at a doctor’s office is full of patients. The Nurse Practitioner on vacation this week, the office manager squeezes in several unscheduled patients before Noon followed by a lunch meeting with the malpractice insurance broker. Meanwhile a pharmaceutical rep hovers in the hallway waiting for a signature, and the current patient in room 4 is complaining because he had to wait 30 minutes for a 5 minute visit. Sound familiar? This is a typical, stress-filled day for most busy physicians in private practice.
Now add 32 million previously uninsured patients looking for healthcare to that scenario – how will doctors keep up with the demand? And where will patients find care if doctors can’t keep up?
Where is this demand coming from?
Since the implementation of the Patient Protection and Affordable Care Act signed into law in 2010, many healthcare experts have been warning of an impending physician shortage in the U.S. In fact, due to the increasing number of baby boomers reaching Medicare age, the shortage was predicted before Obamacare ever came along.
Medicare officials expect enrollment to grow by 40% or more by 2025 because of the aging U.S. population.
According to a census performed by the Federation of State Medical Boards in 2010, there are 850,000 physicians licensed to practice medicine in the U.S. A percentage of those are no longer practicing but still have an active license.
The Association of American Medical Colleges (AAMC) reports that we will have a shortage of 90,000 physicians by 2020 growing to 150,000 by 2025. About half of the void will be in primary care physicians. Just as the number of patients is increasing, fewer and fewer young people are choosing the medical profession – especially primary care. Those that do choose to go to medical school are specializing.
Where have all the general medical practitioners gone?
There are several reasons for this shift, but it’s mostly financial. Med students typically graduate with the burden of a great deal of debt. Student loans take years to pay off, and so, students want to maximize their earning power by going into the higher paying specialties. According to a 2010 Medical Group Management Association (MGMA) study, primary care physicians make about half of what their colleagues make practicing in a higher risk specialty.
For many, lower incomes + higher volume of patients + rising cost of medical liability insurance + the stress of managing a private medical practice = a lesser quality of life for the primary care physician and that fact is working against any significant growth in this area.
Besides a heavier patient load for physicians, what’s the big deal?
The overall quality of healthcare is at risk. More patients and fewer doctors means people will have to wait a lot longer to see their physicians – if they get to see them at all. A shortage of doctors could mean a lower quality of care due to the pressures on physicians to see more patients and spend less time with each one.
Primary care physicians are already calling on Nurse Practitioners to help, but in the next decade we will see an increased amount of responsibility given to ancillary providers such as Nurse Practitioners, Physician Assistants, and Medical Assistants – responsibilities for which they are often not trained. This has physician and consumer groups worried.
How does Affordable Care Act (ACA) address the problem of physician shortage?
Reimbursements – The ACA has includes increases in reimbursements to primary care physicians for Medicare and Medicaid patients in 2013 and 2014. It is designed to help better compensate current physicians and encourage med students to reconsider their career path although many physicians believe it’s only a temporary fix.
Repayment Assistance – Student loan repayment assistance is another way the ACA is addressing the physician shortage. Newly trained doctors that agree to practice in medically “underserved” areas will be able to get funds to help pay back as much as half of their med school loans. The underserved areas are usually inner cities and rural communities that have a difficult time attracting new doctors. The hope is that this assistance will increase the number of students entering into med schools.
Ancillary Providers – Although not part of the ACA, many see the expanding role of Nurse Practitioners, Physician Assistants, and Medical Assistants as a significant part of the solution. There is currently a push to train these providers to do more than they are traditionally allowed. With increased education and training, ancillaries can help a busy physician treat more patients.
How will the Affordable Care Act affect my medical malpractice insurance?
The challenges of the impending physician shortage will have an impact on physicians’ medical malpractice exposure. Medical Malpractice insurance carriers are always concerned with the number of patients that physicians and hospitals see because the risk for a malpractice suit is increased by the volume of patients.
Less time spent with individual patients can lead to more mistakes or undiscovered problems, especially for family practice physicians. Health professionals need to make sure they have a quality physician malpractice insurance that will cover the risks involved in the continuously changing practice of medicine.