Obamacare calls for nearly $1 trillion in healthcare reforms designed to boost the quality of care in the U.S. and shrink the ranks of the nation’s uninsured, under-insured, and previously uninsurable residents.
But the Affordable Care Act does little to address a deeper problem confronting the U.S. healthcare system that threatens to undermine those goals: A looming doctor shortage that is already hitting patients in many regions of the country.
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According to the Association of American Medical Colleges, the nation is facing a serious shortfall of primary care doctors and will be 91,500 physicians short of what it needs by 2020. That deficit could hit 130,600 by 2025, in part because Obamacare will hike the number of insured Americans seeking care and many doctors are nearing retirement age, getting into concierge medicine, or leaving the profession.
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As a result of those colliding trend lines, the physician shortage has reached a crisis point and will only get worse in the years to come, many health experts believe.
David Brownstein, M.D., a board-certified family physician and medical director for the Center for Holistic Medicine in West Bloomfield, Mich., tells Newsmax TV the doctor shortage parallels the recent problems plaguing the Department of Veterans Affairs. VA facilities have come under fire for forcing hundreds of veterans to wait long periods for adequate care — some of whom died before they could see a doctor.
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"There's a bunch of factors to this but either we make some changes or there's going to be some big structural problems in our healthcare and just what happened to the VA is going to happen to the rest of us," says Dr. Brownstein, a Newsmax
contributor and editor of the Natural Way to Health
newsletter. "We're not going to be able to get appointments with anyone because there's not going to be enough doctors out there."
A key contributing factor to the doctor shortage: Too few medical students are able to secure the 3- to 7-year residency training programs at the country's teaching hospitals, which are required for them to work in medicine after they finish medical school. Federal regulations and funding deficits for those residency programs have capped the number of med students who can participate — a "huge problem" that needs to be addressed, Dr. Brownstein says.
Medicare funds a bulk of the residency training in U.S., providing $9.5 billion a year. But its support was capped by Congress in the Budget Control Act of 1997. Legislation is pending in both the House and Senate that would increase the number of residency slots Medicare would support by 15,000 over 5 years. The measures call for about $9 billion in spending over 10 years — a fraction of the overall costs tied to Obamacare.
Ironically, medical school applications and enrollment are skyrocketing, with a record 20,055 med students starting their first year of study last fall, according to the AAMC. Med-school applications were up 6.1 percent last year over 2012— to 48,014 first-time applicants — surpassing the previous record, set in 1996.
But at the same time more than 500 med-school graduates were unable to land a residency last year — twice the number from 2012 — because of the federal cap on the programs. The expectation is that number will likely grow, unless federal lawmakers act to lift the cap and boost federal funding.
"At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians," said AAMC President Darrell G. Kirch, M.D. "However, unless Congress lifts the 16-year-old cap on federal support for residency training, we will still face a shortfall of physicians…."
Meanwhile, many private practice doctors in the U.S. abandoning solo practices, being absorbed by hospital networks, or are leaving the profession altogether in the face of increasing government regulations on providers. That trend is likely to escalate under Obamacare provisions that aim to hold down costs by creating new Accountable Care Organizations that take a team approach to patient care and pay providers in "bundled payments" as an alternative to traditional fee-for-service practices.
A recent American Medical Association study found there has been a dramatic reduction in solo physician practices over the past 30 years — from 40.5 percent in 1983 to 18.4 percent in 2012. In addition, only about half of physicians (53.2 percent) were self-employed in 2012; nearly 30 percent either directly for a hospital or for a practice that was at least partially owned by a hospital; and single specialty practice was the most common practice type in 2012, accounting for nearly half of all physicians.
Michael Murphy, M.D., co-founder and CED of the medical information outfit ScribeAmerica, has compared the trend to disappearance of the corner store amid the rise of big-box retailers.
"This is not unlike the 'ma 'n' pa' corner store's disappearing act under the shadow of giant super stores," he says. "The doctor, once the captain of the ship in his or her thriving private practice, has all but been forced out by insurance companies, hospitals, and guideline policy makers in order to simply survive the shrinking healthcare dollar."
Dr. Brownstein predicts the increasing pressures on doctors will only drive more to leave the profession over the next decade, unless changes are made to boost the number of young new physicians moving into primary care practices and healthcare regulations are eased.
"Doctors are having more and more troubles out there. There's too many insurance companies, there's too many regulations, too much paperwork, and too many hoops to go through for doctors to be in private practice right now," he says. "And that's … why there's been such a decline in private practice, and why there's so many part-time doctors, and why we're having such a shortage of doctors."
He also believes more needs to be done to financial incentives for med students to choose primary care over more lucrative medical specialties, noting medical college loan debts can add up to $300,000.
"There’s a disincentive to be a primary care doctor because the specialists are paid more," he explains. "So either we pay the family doctors a little bit more and we cut … what we're paying the specialists — and open up residency slots — or I don't see a way out of this situation."
Dr. Brownstein adds that the consequences for patients are significant, as the U.S. population ages. Census Bureau figures project about 10,000 Americans will turn 65 every day over the next decade, and health statistics show seniors over 65 use twice as many healthcare services as those under 65.
"There certainly is enough money out there to do what we want to do," he says. "We just need to spend our money more wisely and start looking at where the money is going and it shouldn’t be going to insurance companies, it shouldn’t be going to [regulators, and] big PHARMA; it should be going to the people who are seeing the patients.
"Either we get it fixed or we're just going to be in a worse boat as the population ages."
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