October 7, 2008

If America gets UNIVERSAL healthcare...we better make sure we get more primary care doctors, too.

Universal healthcare is the magic key that could unlock many doctor offices' doors that currently remain shut and locked to most of the nation's uninsured population....but could universal healthcare also unlock a sort of healthcare "Pandora's Box"? A box that, when opened, creates a shortage of primary care physicians, longer wait times, and a reliance on emergency rooms for routine medical care?

According to two recent Boston Globe articles, Massachusetts, the first state to mandate health insurance in 2006, not only has a chronic primary doctor shortage but also has a wait time as long as 100 days just to see a primary care doctor. In its annual survey of physicians, the Massachusetts Medical Society found that among 100 internists the average wait time for an appointment for a new patient was 50 days, with some reporting waits up to 100 days. As a result, thousands of newly insured Bay State residents are relying on emergency rooms for routine medical care, which the Globe describes as "an expensive habit that drives up healthcare costs and thwarts a major goal of the state's first-in-the nation health insurance law."

So if the entire state of Massachusetts is finally insured, why are its residents STILL having problems receiving medical treatment? Plain and simple: there just are not enough primary care physicians to see the 439,000 newly insured patients.

A national primary care shortage has been looming for several years as doctors retire or leave the specialty and fewer doctors are entering the field. The Massachusetts Medical Society found that fewer primary care doctors are taking on new patients, and 42 percent of internists surveyed have closed their practices to them, compared with 33 percent in 2004. According to a survey published this month in the Journal of American Medical Association, just 2 percent of students graduating from medical school plan to practice primary care. Additionally, physicians are choosing to practice other fields since primary care requires long, unpredictable hours and pays less than most other medical specialities.

With all this said, does this mean then if the United States has a universal health plan that the nation will face the same shortage of primary care physicians and increase in wait time that Massachusetts is currently facing? Frankly, I think this a very likely possibility....BUT, in the same way that Massachusetts was the first state to mandate healthcare in the U.S., it is also the first state to deal with these post-mandate problems and therefore the first to work through them and find reliable solutions. For example, the state's law includes $1.5 million this year to help the University of Massachusetts Medical School expand its class size and to waive tuition and fees for students who agree to work as primary care doctors in Massachusetts for four years after they finish training. Massachusetts is also spending $1.7 million this year to repay medical school loans of doctors who agree to work in community health centers, and at least $500,000 to pay off debt for doctors who agree to work in primary care in underserved areas for at least two years....and considering that the average medical school student graduates with about $150,000 in debt, this $500,000 offer is quite an incentive.

Universal healthcare is a viable solution to the nation's 47 million uninsured and we should not let Massachusetts' problems scare us away from the idea....instead we should learn from the Bay State's ways and urge our government to produce legislative initiatives that would reduce the administrative burden on doctors and, as a result, the wait time for patients. And since such initiatives can have a long lag time, the sooner the government gets started....the better.

Click below to read the Boston Globe articles in their entirety:

Sept. 22, 2008 Boston Globe article:
Across Mass., wait to see doctors grows

Oct. 6, 2008 Boston Globe article:
Costly ER still draws many now insured

What are your thoughts about Massachusetts' healthcare mandate? Do you think national universal healthcare is within our horizon? Share your thoughts and opinions on the topic!