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Insurance Does Not Guarantee Access…and We’re Short on Docs

Make no mistake about it: there is a severe doctor shortage in the United States and the problem is only getting worse, especially in primary care. The Association of American Medical Colleges estimates that we could face a shortage of as many as 150,000 PCPs in the next 15 years. The reasons for this trend vary, though the comparatively lower pay, steep medical school debt, and even the personality types of those accepted to medical school are clear contributors. As a future physician, I understand the implications (and potential consequences) of this reality, and recognize that swift action must be taken. The health reform law makes significant improvements to the status quo by setting a clear priority for docs to enter primary care. Some of the provisions include:

-Up to $1 billion annually for the National Health Service Corps (a loan forgiveness program for PCPs to provide care in shortage/underserved areas)
-$125 million annually for state loan forgiveness programs in primary care
-A 10% Medicare payment bonus to primary care physicians
-Increasing Medicaid payments to Medicare levels
-Shifting unused residency slots to high-need primary care areas
-Expanding primary care residency to non-traditional (non-hospital) sites such as community health centers

-$50 million annually to expand Teaching Health Centers, with $230 million appropriated for primary care training

Though these efforts will surely be of benefit, many recognize that the root of the problem is a shortage in medical resident positions. In 1997, Congress capped the number of resident slots at 15,000, as training is tied to Medicare payments. It will be necessary to revisit the expansion of this funding (currently $9.1 billion), which did not make it into the legislation. More-so, it will be necessary to think outside the box, with a focus on non-physician providers like Nurse Practitioners and Physicians Assistants. Though somewhat controversial in expanding their scope of practice into traditionally physician’s turf, the endeavor is promising (if not essential) in order to tackle the issue.

Below are some of the law’s provisions related to the role of nurses:

-$50 million to nurse-managed health clinics that offer primary care to low-income patients.
-$50 million annually from 2012-15 for hospitals to train nurses with advanced degrees to care for Medicare patients.
-10 percent bonuses from Medicare from 2011-16 to nurse practitioners, who work in shortage areas.
-A boost in the Medicare reimbursement rate for certified nurse midwives to bring their pay to the same level as a doctor’s.