I feel lately this issue is going to be front and center during the eventual presidential debates, especially if the economy improves. I personally do not feel 100% confident correlating the passage of the affordable care act to a subsequent decline in qualified medical professionals. There are just too many factors to consider plus the Olympics are on and I have a 14 month ball of energy waiting for me every night at 7. Not enough time in the day to do the extra analysis at this point.
But I thought I would lay out some of the principal talking points and link you all to some pertinent articles on the subject. First up, Annie Lowrey and Robert Pear at the New York Times posit that coverage might not translate into care. Rural areas in particular, according to the authors, will be hit the hardest. The problem has been aptly named the “invisible problem” by many in the field as patients will still receive care, but it will progressively become slower and more difficult. The article has some great stats, highly recommended.
Suzanne Sataline and Shirley S. Wang at the Wall Street Journal write that over the next 15 years the U.S. could face a shortage of as many as 150,000 doctors. Greatest in demand will be primary care physicians but every medical school graduate knows that by specializing they can make on average $3.5 million over the course of their careers as compared to primary care physicians. Interestingly this has stigmatized those pursuing the primary care route as less intelligent or talented. Now, incentives are being put in place to draw more folks back to primary care. This might work, similar to governments incentivizing bright college kids to study education and enter into the teaching profession. But I gather these will be steep and costly and in the end still might not achieve the desired break-even point. This same Wall Street Journal article has a nice graphic at the end showing the number of primary care physicians per 1,000 people. States like Nevada, Idaho, Utah, Texas, Oklahoma, Mississippi, Alabama and Georgia have fewer than 1.
Sarah Kliff at The Washington Post echoes the economics argument regarding doctor salaries. “A third of their class (primary care residents at Children’s National Medical Center) has more than $200,000 each in student loan debt. At the end of residency, they can stay in primary care and earn $29.58 an hour. Or they can specialize and make $74.45. Over a lifetime, a medical student who specializes can expect to earn $3.5 million more. The Obama administration — and, arguably, the American health-care system — desperately needs them to choose primary care.”
She goes on to mention … “Decades of research have confirmed that more specialists leads to more specialty care, which leads to a more expensive system. Now, with the passage of the Affordable Care Act, tens of millions of previously uninsured Americans will be looking for a primary-care doctor. It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest.”
But now for some good news. What about increasing the influx of Dr.´s from abroad? Dean Baker at Business Insider points out that U.S. doctors earn on average twice as much as their equally trained counterparts in Canada and parts of Western Europe. Compared with doctors from the developing world, a whopping 5 to 10 times as much. Fast-tracking these folks to the U.S. could patch a huge shortfall. Now, I can already see a backlash from the brain-drain community and how this movement could fly directly in the face of U.S. policy to promote development in under-developed countries by ensuring their best and brightest stay at home to develop their own communities and not chase the American dream abroad. This will be tricky to manage for either Obama or Romney.
Regardless of where you fall on the affordable care act this appears to be an issue that will be with us for some time.