The Doctor Shortage Cometh
There has been plenty of talk about the impending fixes to the ill-designed, barely-functioning healthcare.gov website. Although the "glitches" should be fixed eventually and the site will execute as it should, there are far serious problems looming on the Obamacare horizon.
The lynchpin of healthcare services are the physicians who deliver care. But the climate for physicians to practice and the attraction of entering into medicine is quickly souring.
After the launch of the Affordable Care Act, physician compensation began to fall. "Doctors must now see many more patients each day to meet expenses, all while dealing with the mountains of paperwork mandated by the health-care law."
And not only is the current climate unfavorable to the physician, it is less appealing for people to enter the profession in the future.
It started in 2014 when the ACA cut $716 billion from Medicare to accommodate 30 million newly "insured" people through an expansion of Medicaid. More important, the predicted shortage of 42,000 primary-care physicians and that of specialists (such as heart surgeons) was vastly underestimated. It didn't take into account the ACA's effect on doctors retiring early, refusing new patients or going into concierge medicine. These estimates also ignored the millions of immigrants who would be seeking a physician after having been granted legal status.
It's surprising that the impending shortage was not anticipated. After health insurance was mandated in Massachusetts (Romneycare) "the wait to see a physician in some specialties increased considerably, the shortage of primary-care physicians escalated and more doctors stopped accepting new patients. In 2013, the Massachusetts Medical Society noted waiting times from 50 days to 128 days in some areas for new patients to see an internist, for instance." Perhaps the architects of Obamacare weren't interested in learning this.
The ACA cut $716 billion dollars from the Medicare budget, which further lowered the reimbursement levels for hospitals and doctors. Doctors simply refused to accept Medicare patients along with the excessive paperwork and lowered reimbursements. Seniors and those close to Medicare eligibility are will be hit the hardest.
Further eroding the physician landscape is the decline of the private practice. "Because of regulations and other government disincentives to self employment, doctors began working for hospitals in the early 2000s, leaving less than half in private practice by 2013. The ACA rapidly accelerated this trend, so that now very few private practices remain."
The result is a growth in concierge medicine. Concierge medicine is an industry where a patients pays a yearly "membership" fee to a primary care physician who works with a smaller client base. The typical ACA physician will have a client base of 3-5K patients where as a concierge physician will see only 300-500 people. The trend is stretching to specialists and surgeons who opt out of government organized healthcare and work on a strict fee-for-service model.
The consequence of this leaves us worse off than when we started. People happy with their healthcare are getting kicked off their plans and forced on to more expensive insurance with compromised quality care. Those who can afford it will simply pay out of their pocket for services further exacerbating class differences in medical care delivery.