ASHINGTON – Primary care physicians already are in short supply in parts of the United States, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.
WASHINGTON – Primary care physicians already are in short supply in parts of the United States, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain The new law, signed by President Barack Obama last week, goes beyond offering coverage to the uninsured. It includes steps to improve the quality of care for the average person and help keep Americans well instead of the country’s current seek-care-after-you’re-sick culture. To benefit, people will need a regular health provider. Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack. The big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online. However, only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last year reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the northeastern state implemented its own program to provide nearly universal coverage to its residents. A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office visit, a "medical home" would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most. "A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months," says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model. "We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform," adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care. Pilot tests of medical homes, through the American Academy of Family Physicians and the government’s Medicare program for the elderly, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money. Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice. "What we need is not just a medical home, but a medical neighborhood." AP
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