Massachusetts’s experience also provides some reassurance. When the state approved universal health care in 2006, there was a backlog of new patients, plus long wait times to see a primary care physician. “Yes, we have a shortage of doctors, but now everything has settled down and everyone is getting better care,” says Mario Motta, M.D., president of the Massachusetts Medical Society, the statewide professional organization of physicians. In 2008 the state approved unprecedented financial incentives that made primary care careers more attractive to new physicians and nurses. Class sizes were expanded at the University of Massachusetts Medical School, and tuition was waived for students who agreed to work as primary care doctors in the state for four years after they finished training. Today about 96 percent of the state’s population is insured—the highest rate in the nation.
Patients themselves can play an important role in ensuring access. “They should be proactive and establish a relationship with a doctor before they get sick,” says David Reuben, M.D., chief of Geriatric Medicine at UCLA. “Planning your health care is no different than any other investment you make for the future. You want a primary care physician who knows you and your health issues, and can guide your care, including referrals to specialists when appropriate.”
2. Seeing a specialist—when you need to
Specialists currently dominate the medical field—roughly 70 percent of medical residents become orthopedists, gastroenterologists, or some other specialists—so patient access to them has been less of a problem than access to a primary care physician. That’s not likely to change anytime soon. “Getting into a hospital to have surgery is not going to be a problem, because our medical profession is overwhelmingly made up of interventionists like surgeons,” says Paul Torrens, M.D., professor of Health Services at the UCLA School of Public Health.
As health care reform takes hold, however, specialty care itself may change. “We’re going to see changes in how specialty care is provided, by online or telephone consultations, or by the primary care doctor consulting with a specialist without the specialist actually seeing the patient,” Reuben says. “In some managed care organizations this is happening now.”
Telemedicine, as this type of consultation is called, is often used to determine whether a patient in a remote or underserved region of the country needs to see a specialist. In urban centers where specialists are plentiful, though, seeing a specialist will be part of routine medical care, much as it is now.
To further reduce the demands on the system, specialists and patients alike will need to become more responsible about evaluation and treatment. “We have this notion that we should have unlimited access to medical care and all manner of tests,” says Newman. “But are they always really necessary? We need to provide appropriate tests. It’s not a matter of rationing; rather it is doing what’s appropriate and necessary for the care of the patient.”