Primary Care Doctors Will Become More Scarce

January 22, 2014

America's supply of primary care doctors is diminishing, says Scott W. Atlas, a senior fellow at the Hoover Institution.

As Americans age and join the health exchanges, access to primary care is going to be essential. In theory, the Affordable Care Act (ACA) will add 30 million more nonelderly to the insured pool by 2022.

  • Due to the ACA, there will be an estimated additional 15 million to 24 million primary care visits, which would mean that the United States will need an additional 4,307 to 6,940 primary care doctors by 2019. This number is on top of the estimated additional 44,000 to 46,000 doctors that will be needed over the next decade and a half to meet future primary care demand, even without the ACA.
  • But the supply of primary care doctors is already dwindling, as doctors seek to specialize in more technologically-advanced and higher-paying fields. Of those primary care doctors that are still practicing, many are forming concierge practices to escape growing regulations. Between 2011 and 2012, the number of concierge doctors in the United States increased by 25 percent.
  • Already, 36 percent of doctors will not accept new Medicaid patients and 20 percent of primary care doctors refused to see new Medicare patients in 2012.

The Obama administration is trying to prioritize primary care over specialist care.

  • The ACA promotes increasing payments to primary care providers by taking payments away from specialists.
  • The Medicare Payment Advisory Commission has recommended cuts in reimbursements to specialist doctors, reducing fees for non-primary care services by 5.9 percent each year for three years, then freezing them for the rest of the decade.
  • This would be a 50 percent cut in specialist incomes.

This is not the right way to improve health care quality. Specialty care has been responsible for improved survival and lower rates of suffering. Specialists should be rewarded for their extra training, and the United States needs to attract the best students into medicine.

Primary care access should be increased, but this can be done -- and made more affordable -- by expanding the number of outpatient clinics in retail settings. This, along with allowing care by non-physicians such as nurse practitioners and physician assistants, can improve access to care while reducing costs.

Source: Scott W. Atlas, "The Doctor Won't See You Now," Hoover Institution, January 21, 2014.

 

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