Doctor shortage looms in Massachusetts, USA
Jul 28, 2007 - 4:26:01 AM

The Massachusetts health reform plan is in full swing, but so is an acute doctor shortage that may curtail the state's goal of providing care to hundreds of thousands of new patients who will want it, according to a new study.

Today, new patients wait an average of 52 days to see an internist or family doctor for a routine visit, according to the physician workforce study by the Massachusetts Medical Society.

And about half of all internists have stopped accepting new patients.

``We are down by hundreds, if not thousands of primary care physicians,''

B. Dale Magee, president of the Massachusetts Medical Society told United Press International.

Add to this the 500,000 new patients expected to enroll in the state's new health plan this year and Massachusetts may have a crisis of healthcare access on its hands, Magee said.

``This is particularly important because of health reform. We expect demand to increase, as individuals come on board,'' Magee said.

The primary care shortage has been ongoing for a number of years, but is worse today. An overall shortage exists throughout much of the United States, he said.

The backbone of Massachusetts' plan, considered by some a model for the nation, is a mandate that almost every uninsured person must obtain health insurance or be penalized. Massachusetts has the most expensive healthcare and health insurance in the United States.

Insurers have created new insurance plans in order to extend coverage to many of those currently without it.

The new insurance plans are considered lower cost, with monthly premiums of about $250 for a healthy 37-year-old, with a deductible of $2,000 per year, plus co-pays for doctor visits of $25 to $50 and additional co-pays for prescription drugs. People up to 300 percent of poverty are eligible for subsidized insurance.

Many people will have insurance and access to basic health care for the first time in their lives. Some will bring with them problems that have never been treated, and will require extra attention from their physicians, Magee said.

``It is reasonable to expect that many people who haven't had insurance for many years may require greater intensity of care. For example, they may not know they have diabetes or high blood pressure and those conditions will need to be stabilized,'' Magee said.

Other doctors are in short supply in Massachusetts, too, the study found, including those in anesthesiology, cardiology, gastroenterology, neurosurgery, psychiatry, urology and vascular surgery, according to the study.

Magee believes the state jumped ahead with health reform without a plan to also increase the number of doctors because finally all the players in Massachusetts were finally on board to do something about the uninsured.

``Everyone involved felt we were at a moment in time when everyone was willing to collaborate and was ready to move forward. This may stress the system but in the end everyone will be better off,'' he said.

The main reason for the nearly national primary care shortage is the lower pay of family physicians, who come out of medical school with a massive debt.

``Many if not most studs go in with the ideal and intention of going into primary care. But by the end of medical school, most have been attracted by another specialty. This is understandable because they emerge with $150,000 debt,'' Magee said.

Years ago, more students focused on primary care, Magee said. Part of the reason is that more scholarships and low-cost loans were available then to medical students, compared to today.

What's needed is for a federal and state loan forgiveness program, he said.

And overall medical school enrollment hasn't kept up with the demand for health care. The U.S. population has grown, but also we have an aging population, which requires more care and more obesity in young people, and they need more care, too, Magee said.

``What's happened is part of the gap is being filled by foreign medical school graduates,'' Magee said.

One way to increase the number of primary care providers is to create new health care models built around nurse practitioners and physician assistants, who can provide primary care in a doctor-supervised setting.

The fact that oncologists are paid three times as much as primary care doctors is a policy decision, set by Medicare and insurance companies, said Steffie Woolhandler, co-founder of Physicians for a National Health Program, which advocates one, national health care system.

``Policymakers made this decision,'' and could easily have provided different incentives to promote primary care, she said.

While Woolhandler believes the primary care shortage should be addressed, she is not convinced that the new Massachusetts plan will cause a run on health care.

``People above 300 percent of poverty have huge deductibles. Even though they will have insurance it's not clear to me that their access will improve,'' she said.

``What we need is a plan that gives people real access,'' she said.

Stephen Schoenbaum, executive vice president at The Commonwealth Fund, which studies health plans, believes that market forces will take care of the primary care physician shortage.

``It was very perceptive of Massachusetts to enact its health reform and if now it is discovering that there's a shortage of primary care physicians that will be the next problem that will be addressed,'' he said.

``No one is going to put the supply there until there is a demand for it,'' he said.

In terms of the difference in salaries between primary care doctors and specialists, ``there is no logical reason why it can't be addressed,''
he said.

``You may get concerned that this will make health care more expensive, but in fact we know that in parts of the U.S. where there is a larger supply of primary care physicians compared to specialty physicians, that there tend to be lower costs and better outcomes,'' he said.

Copyright 2007 by United Press International.
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