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The primary care shortage starts now

Donald Berwick, as head of the Centers for Medicare and Medicaid, must find a way to dramatically increase the supply of primary care even while the number of primary care doctors shrinks dramatically.
Written by Dana Blankenhorn, Inactive on

It doesn't take an economist to understand that if you cut the supply of something while dramatically increasing demand, and refuse to adjust pricing, you are going to have a shortage.

The primary care crisis is on. (Picture of a primary care physician taking blood pressure from Wikipedia.)

A paper in today's New England Journal of Medicine describes how 30,000 recent immigrants had their coverage transferred to a carrier called CeltiCare and quickly found themselves without primary care, despite the carrier's promises.

(NOTE: The article in question was actually published August 4, the day after this was written. My apologies for misreading the embargo date and letting this in early.)

The report was written by doctors at a competitor, Cambridge Health Alliance (CHA), who contacted doctors listed by CeltiCare within their coverage area, and found only a third taking any new patients, with an average wait time of 33 days.

The CHA is linked to Physicians for a National Health Plan, which sent me a link to the study and supports a single-payer health plan for the U.S., but the result could have also been sent by a Tea Party opponent of health reform.

Both sides gain support for their positions from it. There aren't enough primary care doctors to meet demand. Do we ration them based on need, or let the market tell poorer patients they are on their own?

This primary care shortage is not news. The CHA results were easy to verify by any reporter with a phone. Massachusetts has been trying to address the shortage by allowing more limited care facilities, like MinuteClinics, staffed by physicians' assistants or nurses.

Another way to deal with the problem is to import doctors. An advocate for foreign medical schools, John Norcini, has published a study in the journal Health Affairs saying foreign-trained doctors (many from India or Pakistan) do just as well for their patients as American-trained physicians.

But even taken together, clinics and imports won't really address the shortage in a timely manner. The Affordable Care Act is similar in design and intent to Massachusetts' reform law, which is already running into trouble meeting demand.

All this is about to hit Dr. Donald Berwick full in the face. Medicare is America's low-cost provider of health care. Berwick, as head of the Centers for Medicare and Medicaid, must find a way to dramatically increase the supply of primary care even while the number of primary care doctors shrinks dramatically.

The PA will see you now.

This post was originally published on Smartplanet.com

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