Health Care Reform and Physicians Shortage From a Hospitalist Perspective

A recent BusinessWeek article "Physician, Clone Thyself" suggests an alarming physician shortage in the future due to an increasing access to medical care. The author speculates that once 30 some million additional patients become insured, that will put a tremendous stress on a primary care system. There is already a shortage of the primary care physicians and even more patients 'eligible' to see a doctor will, surely, make it worse.

Lets look at it from a hospital based physician perspective.

Many patients with chronic conditions like Diabetes or Hypertension simply do not have any adequate outpatient follow-up. Thus, these patients use Emergency Rooms and Hospitals as their care providers which add tremendously to the cost of care. Many patients 'have to wait' until their condition is bad enough so that they could go to the Emergency Room and be admitted.

Managing chronic conditions on an outpatient basis might reduce readmission rate and, actually, cut the cost of the healthcare. By preventing complications of many chronic diseases like Diabetes, patients could avoid costly treatments and procedures in the future. For example, being compliant with your insulin will decrease the risk of kidney failure, coronary artery disease, stroke etc. Once those complications develop, treating them is very costly. On a national level it adds up to the billions of dollars.

The problem, though, goes beyond insurance issues. Some patients, even with a good insurance, are simply not being compliant with their treatment. They can afford. They just don't care enough about it to make any changes. And if things get worse? Well, then they just be readmitted to the Hospital since somebody else is paying for it anyway.

As far as shortage of the primary care providers, the problem will likely to get worse. The issue, though, is not the increasing number of the 'eligible' patients. If anything this is a welcome change. This is the whole point of the healthcare reform - to make everybody insured. The real problem is how unattractive the specialty became for the medical students and residents. When I was finishing medical residency, the general attitude was - you have to try to get into fellowship or become a hospitalist. And if you can't, well... than you go to primary care. Oh, and if you are a foreign medical graduate on a J-Visa, you might get stuck doing primary care to get a visa waiver.

We can open a lot more Medical School spots, but until Primary Care becomes more attractive for the new graduates, nothing is going to change.

This article was originally published in http://www.realicu.com blog by Ralph Gordon.

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