The New Health Care Law and the Doctor Shortage

Q. I’m having trouble now finding a primary care doctor. Will it be harder for me to get one when millions more people get health insurance because of this new law?

A. While 32 million people will eventually be added to the rolls of the insured, that won’t happen overnight or in one fell swoop. It will take time, and about half will be insured through state health insurance exchanges, which won’t open until 2014. But you are right—it can be hard to find a primary care doctor who will accept a new patient, especially as the nation’s population grows older and demand increases. During the health reform debate, Republican critics such as Florida Sen. George LeMieux warned that a physician shortage could undermine the entire reform effort: “It’s not health care reform if the doctor is not in,” he said.

The new law addresses the shortage of primary care doctors in three basic ways.

• First, primary care doctors who treat Medicare patients will receive an extra 10 percent bonus from 2011 to 2016, and earn another small bonus if they file health care quality reports with Medicare. In addition, the law adjusts Medicare payments to reflect the variations in medical costs by geographical area, which the American Medical Association says will benefit doctors in 42 states.

The measure also raises payments for family physicians who treat patients in Medicaid, the government’s health care program for low-income people. And it reduces paperwork for doctors who treat Medicare and Medicaid patients—another sweetener to entice physicians into the programs.

• The second way the law tackles the shortage is by providing incentives for doctors to go into the primary care field. For example, it expands loan forgiveness programs to defray the cost of medical school and provides money for primary care training programs at teaching hospitals.
It also provides grants to medical schools to recruit and train students who will practice medicine in rural communities. There are similar incentives for training nurses and other medical providers, which should help ease the demand for primary care doctors.

• Finally, the law encourages changes in how patients are treated by creating “accountable care organizations”—physician and other medical groups—which will be paid according to how well the patient fares, rather than the number of services provided, explained Jean Silver-Isenstadt, M.D., executive director of the National Physicians Alliance. “This means that issues that can be handled over the phone, will be, and patients won’t be required to come in for an office visit just to ensure the physician gets paid,” she said. “This will free up valuable time for doctors to see more patients.”

No one knows for sure whether bonuses and other changes will build up the supply of primary care doctors fast enough to keep pace with demand.

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.