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Health care law will add to doctor shortage

By LAURAN NEERGAARD
March 29, 2010

Health care provider in Miami (AFP)

Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today’s seek-care-after-you’re-sick culture. To benefit, you’ll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.

“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.

“We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform,” adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care.

Only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.

Nationally, the big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online.

Sooner will come some catch-up demand, as group health plans and Medicare end co-payments for important preventive care measures such as colon cancer screenings or cholesterol checks. Even the insured increasingly put off such steps as the economy worsened, meaning doctors may see a blip in diagnoses as those people return, says Dr. Lori Heim, president of the American Academy of Family Physicians.

That’s one of the first steps in the new law’s emphasis on wellness care over sickness care, with policies that encourage trying programs like the “patient-centered medical home” that Jones’ practice is putting in place in suburban Virginia.

It’s not easy to switch from the reactive — “George, it’s your first visit to check your diabetes in two years!” — to the proactive approach of getting George in on time.

First Jones’ practice adopted an electronic medical record, to keep patients’ information up to date and help them coordinate necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who needs what testing or follow-up and make sure patients get it on time.

Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.

Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

“It prevents things from falling through the cracks,” says Dr. Alex Krist, a Fairfax Family Practice physician and VCU associate professor who designed and tested the computer program with a $1.2 million federal grant. In a small study of test-users, preventive services such as cancer screenings and cholesterol checks increased between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of Family Physicians and Medicare, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money.

Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

“What we need is not just a medical home, but a medical neighborhood.”

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EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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On the Net:

American Academy of Family Physicians: http://www.aafp.org

Fairfax Family Practice Centers: http://www.fairfaxfamilypractice.com

Dartmouth Institute for Health Policy and Clinical Practice: http://tdi.dartmouth.edu/

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14 Responses to Health care law will add to doctor shortage

  1. AustinRanter (AKA Gregg)

    March 29, 2010 at 3:14 pm

    I don’t know why this issue wasn’t the center piece of debates about Health Care reform.

    The HC Act will evolve completely unlike when Medicare was enacted. During Medicare’s first year, only about 3.7 million of the 19 million who were technically eligible received medical services.

    Now, with the new HC Act… 32 million will be dumped into the laps of current providers almost instantly. There is virtually no way to construct a health care infrastructure that can adequately meet the need of such a population by 2014.

    Up till now…indigent needs are provided via County or Parish hospitals. They usually provide limited services. Certainly life and dealth medical problems are attended. But there is virtually no preventative care or the types of illnesses that can under certain circumstances escalate into serious to life threatening problem (i.e. flu or cold symptoms that turn into pneumonia).

    IMO, there will have to be unpleasant side affects from 32 million rolling into the HC system. I think that on the top of the list of the impending side affects will be the forced rationing of every day treatment issues all the way to long-term care.

    I don’t think that most people realized that in the latter days of President Eisenhower’s term in office there was a law created to help the elderly. It was the Kerr-Mills Act of 1960. So there was actually 5 years of services in place, as limited as they were, to buffer society’s transistioning into the Medicare program.

    • griff

      March 29, 2010 at 4:40 pm

      Because they don’t want you to know how bad it is until it’s too late to do any thing about it.

  2. woody188

    March 29, 2010 at 4:35 pm

    I only contract with one GP, but he and the 4 specialists I work for all say this law is going to hurt them and force them to provide worse care.

  3. Almandine

    March 29, 2010 at 10:23 pm

    Sounds like reform to me…

    and it reminds me of the big threat during my boyhood days:

    Do something bad and get sent to “reform school”.

    If only they’d known.

    • griff

      March 30, 2010 at 8:11 pm

      Yeah where about to get schooled in what ‘reform’ really means. In government-speak that means they take some thing they’ve already bastardized, grant special monopoly priveleges to their campaign financiers and other assorted cronies, take a large chunk of taxpayer money to feed the new bureaucracy’s voracious appetite, and ultimately ruin it.

      Of course, that just paves the way for future ‘reforms.’ Call it job security.

  4. woody188

    March 30, 2010 at 3:01 pm

    The response of the politicians to these isolated threats reveals the utterly dishonest nature of all political systems. CNN informs us that “Democrats discuss concerns with police, FBI.” If these legislators truly believed that they were acting in the interests of those who voted for them – instead of the corporations and governmental bureaucracies who promoted the measure – why don’t the “Democrats discuss concerns” with their alleged constituencies?

    Excerpt from The Costs of Human Action by Butler Shaffer

    • b mcclellan

      March 30, 2010 at 4:27 pm

      Woody, I applaud again the breadth and scope of your research.
      Homo boobus indeed.

      The man who knows what freedom means, will find a way to be free. F.H.Harper.

      Reminiscent of the P.O.W. lament,
      They have my body, but they shall never possess my mind.

      Here come the H-1b’s..

      • woody188

        March 30, 2010 at 10:26 pm

        LOL, that one was worth sharing. :)

  5. Guardhouse lawyer

    March 30, 2010 at 3:11 pm

    This issue was raised here some months ago and you people heckled the guy off the site. I don’t understand the ethics of this place, primarily because I don’t see too much of them.

  6. b mcclellan

    March 30, 2010 at 3:32 pm

    Please refresh our memory GHL.

    • Guardhouse lawyer

      March 30, 2010 at 7:31 pm

      Can’t remember the guy’s name, but he had a friend who was also here who died. You people treated both of them like warmed over shit.

      • b mcclellan

        March 30, 2010 at 8:42 pm

        I’ll give you that much very little GHL.
        This is the fairest and most open venue for honest debate on wire or wave.

        Gazelle was treated with kid gloves as according to protocol, I wish her well. Procustus is beyond my power to resolve and is missed.

        Here above all else is to bring sanity to the table too which,
        the hunt for……..,
        is on,… and on…. etc.

  7. Almandine

    March 30, 2010 at 7:45 pm

    What’s your point?

  8. b mcclellan

    March 30, 2010 at 9:42 pm

    Lets say one thing about wealth-care ;

    A true practice of medicine or trade resultant in good can only be successful given freely ,
    sans the pride and position of the giver.

    Lets for instance examine the plight of Americas military, from the perspective of Mission with a purpose. When was the last time clarity reared it’s head ?
    When Johnny comes marching, or limping, or missing something has he every right to the same care if not better than the chicken hawks that sent him/her ?
    There are no fine points to argue, it comes to defense and the ultimate demise of our final humanity lest we recognize the cost militarization in the womb besets and assails us all.