Doctor Shortage?


Will There Be Enough Primary-Care Physicians To Treat New Medicaid Patients?


Under the terms of the health-care overhaul law, about 16 million people will join the Medicaid rolls starting in 2014.

But once that happens, will there be enough doctors, particularly those focused on primary care, to treat them?

study out this week from the Center for Studying Health System Change (CSHSC) comes to a sobering conclusion: in most areas of the country, growth in Medicaid enrollment will “greatly outpace” growth in the number of primary-care doctors who accept the joint federal-state insurance program.

There are a couple of strands to this problem. Physician groups and policy-makers have been warning for years — well before the Affordable Care Act was even a gleam in President Obama’s eye — that we are facing a shortage of physicians in general, and particularly of primary-care doctors.

Yesterday was “match day,” when U.S. medical students find out where they’ll be spending their residencies, and the National Resident Matching Program reported an increase in the popularity of family medicine. But the American College of Physicians warned that despite the “positive sign” of an increased interest in internal medicine residencies, “the U.S. still has to overcome a generational shift that resulted in decreased numbers of students choosing primary care as a career.” That’s a problem for everyone.

The health-care overhaul is expected to exacerbate the doctor shortage by increasing the number of people, previously uninsured, who can now obtain care. (The law does include provisions intended to boost the overall number of primary-care docs.)

But Medicaid patients have an additional hurdle: in 2008, only 42% of U.S. primary-care doctors accepted new patients covered by the program, due to its low reimbursement rates and other factors. By contrast, 61% of primary-care doctors reported accepting new Medicare patients and 84% accepted all or most privately insured patients, according to CSHSC.

The states that are likely to see the biggest increases in Medicaid enrollment now have the smallest number of primary-care doctors per capita, and vice versa, the study finds. The data come from a 2008 CSHSC survey of physicians.

The health-care overhaul bill includes some sweeteners meant to increase the appeal of accepting Medicaid patients, namely temporarily increasing reimbursement to the same levels as Medicare reimbursement for certain primary-care services.

But, the analysis finds, some states are already reimbursing for Medicaid at 100% or more of Medicare rates — particularly the states that happen to be relatively low on primary-care doctors. So those incentives, which only last for two years in any case, aren’t likely to significantly increase the supply of Medicaid-accepting primary-care doctors in the states that need them most.

The report concludes that increases in reimbursement rates alone “cannot increase the supply of Medicaid PCPs to levels necessary for the likely growth in the Medicaid population,” so there must be other changes, including a push for more integrated and organized systems of care.

Image: iStockphoto



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