Thursday, March 5, 2015

Congress fiddles while doc shortage looms -- March 5, 2015 column


You’re not the only one getting older. Take a look at your doctor.

One in 10 active physicians is between the ages of 65 and 75 – retirement age. More than a quarter is 55 to 64 -- likely to retire within the decade.

The graying of our doctors and ourselves is part of the larger problem of access to health care. The goal of the Affordable Care Act, or Obamacare, is to help everyone get insurance. Then what?   

If you have health insurance through your employer or a public program such as Medicare, Medicaid or the Veterans Administration – as nearly 85 percent of us do -- access depends on when you can see your doctor. That can be days, weeks or even months.

Seeing a doctor likely will get only more difficult, unless Congress acts. And even that won’t solve the problem.

By 2025, the nation will be short 46,000 to 90,000 physicians overall, the Association of American Medical Colleges warned Tuesday in its latest study, “The Complexities of Physician Supply and Demand: Projections from 2013 to 2025.”

The study, which based its findings on demographic trends and changes in health care delivery and payment policies, projected a shortage of 12,000 to 31,000 primary care physicians and 28,000 to 63,000 specialists, notably surgeons of various types.

“The doctor shortage is real – it’s significant – and it’s particularly serious for the kind of medical care that our aging population is going to need,” said Dr. Darrell G. Kirch, the association’s president and CEO, in releasing the report. The association represents 158 medical schools, 400 teaching hospitals and 51 Veterans Administration medical centers.

The physician shortage showed up last summer at VA facilities with delays in care, Kirch told reporters. He noted that the over-65 population in the United States is projected to grow 46 percent by 2025.

Older, sicker people need more medical care, but physicians already say they’re overworked. In a survey last year, 81 percent described themselves as over-extended or at full capacity, and only 19 percent said they had time to see more patients.

Forty-four percent planned to cut back on patients seen, work part time, close their practices to new patients or retire, the 2014 Physicians Foundation nationwide survey found.

By the way, if you’re inclined to blame the influx of newly insured people through Obamacare, don’t. Even though an estimated 26 million people eventually will have insurance or other health care coverage through the law, those patients now are projected to increase the demand for physician services by only 2 percent or 16,000 to 17,000 doctors, the medical colleges’ report said.

Overall shortfall projections in the medical colleges’ study are smaller than those in 2010, when its study estimated a 130,600-physician shortfall. The lower shortfall numbers reflect such changes as more physicians completing their training and lower Census projections of the population, the new report said.

Medical groups want Congress to raise the cap on the number of medical residencies from about 29,000 a year to 32,000.That would cost about $1 billion every year through 2025, Dr. Janis M. Orlowski, chief health care officer of the medical colleges association, says. Medicare pays $40,000 of the $152,000 a year it costs to train a medical resident.

The cap was set “temporarily” in 1997; attempts to lift it have languished in Congress for years. Even if Congress does find $10 billion to boost the number of residents, though, other changes will be needed, experts agree.

An Institute of Medicine report last July said that the doc shortage is mostly geographical; many doctors train in New Jersey, New York and Massachusetts – and stay there to practice. Plus, a reallocation between primary care and specialist residency slots is needed.

A bright spot is the rapid growth in the number of advanced practice nurses and nurse practitioners and their increased role in delivering care. But, says the medical colleges’ report, “even in these scenarios, physician shortages are projected to persist.”

Here’s a problem Republicans and Democrats in Congress should tackle together – and soon. They’re not getting any younger either.

©2015 Marsha Mercer. All rights reserved.


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