The key barrier to health care reform

The key barrier to health care reform is a growing shortage of first-line family physicians. (From VirginMedia we have Dr. Hibbert, the Cosby-accented family doctor on The Simpsons.)

Call them internists, or family doctors, or general practitioners. Call them whatever you want. Every plan for health care reform, whether from left or right, calls for you to see them more regularly, and we just don't have enough.

Take my home state of Georgia for instance.

This spring, 385 students graduated from Georgia's medical schools, but only two of them chose to remain in the state to pursue a family medicine residency. Overall, 20 students, or 5 percent, chose to go into family medicine — half the number that it was just five years ago.

The Atlanta Journal-Constitution story goes on to describe how this is a growing nationwide shortage and to interview a foreign-born doctor who chose the road less traveled.

I described this a few months ago in a story about Massachusetts' attempt to reform health care. The state has approved in-store clinics and doc-in-a-box operations, but the care gap continues to grow.

The correct market response is to raise salaries, but the reimbursement systems of our health care system are actually lowering take-home pay for many family doctors, by raising the costs of getting paid.  

The best route to a raise is to ease the pain of reimbursement, and to use those savings to raise rates for family care. Trouble is that in the short run this would enable some to cut back, to stop taking new patients and to do better with those they have.

We could also make it easier for specialists to move back into family medicine. But it will take time in any case.

I guarantee that U.S. health care in 2013 will be little better than it is today, because it takes time for changed incentives to reach the doctor on the line.

Can we at least start turning the ship around by then?