The doctor will see you now. Or the nurse. Or the physician assistant.

June 10, 2013

Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.

Here's one question that keeps health policy wonks up at night: As millions of Americans gain health insurance coverage over the next decade, who will see them?

It may well not be a doctor: The Association of American Medical Colleges projects that the United States will have 91,500 too few physicians to treat the country's medical needs. It might be a physician assistant or a nurse practitioner. States like California are moving forward on legislation that would give providers like this stronger abilities to practice independently, with less physician oversight.

A new paper in the journal Health Affairs suggests certain demographics might be just fine with that.

"We've been expecting a shortage of physicians for awhile," Clese Erikson, who directs the Association of American Medical Colleges' Center for Workforce Studies. "Nurse practitioners and physician assistants are seen as an important part of securing access. We wanted to find out consumers' interest in seeing them."

 Erikson co-authored the new research, which surveyed over 2,000 patients who had received medical care over the past year and asked them a few questions on who they would like to receive care from in a follow-up situation. If the patient had a worsening cough or frequent, painful headaches, what type of medical provider would they want to see.

If a doctor was available that same day, most respondents wanted to see the physician. But if seeing the doctor meant a day or two wait, preferences tended to switch to nurse practitioners and physician assistants. Here's what that looks like in graph form, courtesy of Project Millennial.

With a one-day wait, preference for seeing a nurse practitioner or physician assistant jumps from less than 30 percent just over 59.6 percent.

"Particularly when there is a time trade off, patients will prefer to see an NP or PA rather than waiting to see a physician," Erikson says.

Erikson's team also found some big breakdowns by age, when they asked respondents about joining a clinic where both doctors and other providers accepting new patients, with young people more preferring to be seen by a nurse practitioner or physician assistant than those whose first choice would be a doctor.


Older Americans, meanwhile, overwhelming prefer to see a physician. That's a challenge, given that these are the people who tend to require the most health care and who take more frequent trips to the doctor.

Still, there does seem to be some opportunity here as it relates to the health care law: One other finding from Erikson's work is that the uninsured and Medicaid patients tended to show less strong preferences for seeing a physician than those with private insurance coverage or Medicare. These are the exact populations that the health care law will bring into the system.

"While they don't necessarily prefer seeing a nurse practitioner or physician assistant in greater numbers, they were certainly more open to it," Erikson says. "The fact that they're open is encouraging."

KLIFF NOTES: Top health policy reads from around the Web.

Health care has leak investigations, too! "Hundreds of federal employees were given advance word of a Medicare decision worth billions of dollars to private insurers in the weeks before the official announcement, a period when trading in the shares of those firms spiked. The surge of trading in Humana’s and other private health insurers’ stock before the April 1 announcement already has prompted the Justice Department and the Securities and Exchange Commission to investigate whether Wall Street investors had advance access to inside information about the then-confidential Medicare funding plan." Tom Hamburger and Dina ElBoghdady in the Washington Post.

Watch out Snooki: Rules for Obamacare's tanning tax have been finalized. "Republicans have emphasized the tax agency's responsibilities in an effort to further weaken public approval of the healthcare law and capitalize on revelations that the IRS targeted conservative groups for heightened scrutiny as they sought tax-exempt status. The tanning tax, though, has generally not been as controversial as other taxes in the healthcare law — in part because indoor tanning contributes to the risk of developing cancer, which adds to national healthcare costs." Sam Baker in The Hill. 

Arizona is still fighting over whether to expand Medicaid. "Facing a looming budget deadline and a bitterly divided Republican caucus, the state House today takes up Gov. Jan Brewer’s (R) plan to expand Medicaid along with a controversial abortion bill some say is designed to kill the governor’s top legislative priority. The House Appropriations Committee will hold what is expected to be a contentious hearing on the two bills, likely ending with the defeat of Senate Bill 1492, which outlines Brewer’s plan to broaden Medicaid eligibility under the federal health-care overhaul." Mary K. Reinhart in the Arizona Republic

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