doctor-2 One of the major consequences of the recently passed health care reform legislation hasn't generated much attention, let alone debate. What might that be? How about the fact that with tens of millions of uninsured people likely to get coverage over the next few years, who is going to perform all of these additional medical services, and how will costs be controlled as demand quickly races ahead of supply?

The fact is we already face a shortage of primary care doctors in the United States, according to The Physicians Foundation (http://www.physiciansfoundations.org/), a non-profit group that says it "seeks to advance the work of practicing physicians and to improve the quality of health care for all Americans."

Officers of the group have been circulating an op-ed piece on this subject (http://www.physiciansfoundations.org/PressReleaseDetails.aspx?id=195), raising issues that should concern not only health insurers and employee benefit managers, but workers' comp and auto carriers as well--indeed, anyone issuing policies with a medical component.

In 2008, the foundation, working with Merritt Hawkins & Associates, surveyed U.S. primary care physicians and uncovered some very disturbing trends. Among the lowlights, according to the group:

• 63 percent said that increasing paperwork has caused them to spend less time per patient.

• 76 percent said they were either at “full capacity” or are “overextended and overwhelmed.”

• Fewer than 6 percent of physicians assessed their colleagues' morale as "positive," while 78 percent reported that over the past five years the practice of medicine has become "less satisfying."

• Nearly half said that over the next three years they intend to cut the number of patients they see, or to stop seeing patients entirely due to retirement, working part-time or by seeking non-medical jobs.

That's a scary trend, even if we weren't about to make some radical changes in the overall medical care system. Add 30 million more insured patients to the mix, and you have a recipe for disaster, marked by long wait times at best, and rationing at worst.

These trends are likely to be exacerbated by cost-control pressures, as health insurers--denied the ability to pick and choose patients based on their medical conditions when the law takes full effect in a few years--must compete on their ability to negotiate the lowest reimbursements for care, and perhaps delay or even deny services to those not seen as having an immediate or critical need.

Workers' comp insurers, while not directly mentioned in the health care reform legislation, will not be immune to its impact. Indeed, it's likely that all else being equal, occupational health patients may have a tough time getting into see a doctor or physical therapist, or get quick access to critical diagnostic tests, if the country doesn't do something to increase the number of practicing physicians.

And with health insurers really under the gun to control costs--and having far more leverage than their workers' comp counterparts in negotiating fees for services--look for more cost-shifting down the road as providers try to make up for lower reimbursements.

Of course, comp insurers will see some benefits, too. For example, an uninsured patient is more likely to try to file a comp claim, whether or not their injury or illness is work-related. The reform law will ease that pressure.

We're also likely to have a healthier population down the road with millions more insured, which means workers' comp carriers should have an easier time getting those who do get hurt back on the job more quickly.

But the bigger picture isn't pretty. What can we do to alleviate this shortage?

• We'll need a public-private campaign of some sort to encourage more people to become doctors--with incentives to do primary care rather than scatter into specialities. That will probably take scholarship money targeted at medical students, or perhaps even medical malpractice subsidies for practicing doctors. Perhaps insurers with medical components in their policies could kick in some funding, or even lead the charge.

• We should make sure immigration reform makes allowances to recruit more skilled medical students and doctors from around the world to supplement our domestic supply.

• We'll also need medical malpractice reform so that doctors don't waste precious resources on defensive medicine, reserving expensive tests for those who really need them.

• We'll have to consider expanding the use of non-M.D. health care practitioners to handle the more routine cases and relieve the burden on full-fledged doctors.

Whatever we do, we need to move quickly. The shortage of skilled doctors is already a big problem. If we wait for 30 million more people to line up with their brand-new insurance ID cards before we do anything, we'll have a crisis on our hands.

What do you folks think we should do?

Special Reports /

Is There A Doctor In The House?

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