Huge projected shortfall
The greatest threat to the health-care overhaul might not be the Supreme Court, which is scheduled to hear challenges to the law next month. Or the shifting alliances of an election year. In the end, it’s more likely to be a lack of medical providers. If the law succeeds in extending health insurance to 32 million more Americans, there won’t be enough doctors to see them. In fact, the anticipated shortfall of primary-care providers, by 2015, is staggering: 29,800.
Growth of physician compensation and shortage of doctors.
The Obama administration’s options to address that threat are limited. It does have Medicare, which covers the lion’s share of the cost of training medical residents: In 2009, it spent $9.5 billion on residents’ stipends, teaching physicians’ salaries and related expenses. But when Congress passed the balanced budget amendment in 1996, it capped the number of residencies that Medicare can fund. Since then, hospitals’ slots have been tethered to 1996 levels.
The health overhaul, some hoped, would address that issue. But with the health insurance expansion’s $971 billion price tag — and the Obama administration goal to keep the law’s cost under $1 trillion — funds for more slots didn’t turn up.
In the context of a $1 trillion overhaul, the White House’s main effort on this front seems modest: a $167 million sliver of the $15 billion Prevention and Public Health Fund created as part of the health-care law.
“It’s good,” Stream says, “but it’s also a drop in the bucket.”
Last summer the White House launched the Primary Care Residency Expansion at 82 hospitals across the country, with two strings attached: The programs must train residents dedicated to primary care, and the residents must work in underserved areas.
Medical students see good reasons not to sign up, as primary-care doctors often find themselves at the bottom of the pecking order. Research published last month in the journal Family Medicine found that medical students, even those planning to pursue careers in primary care, viewed the work lives of primary-care doctors more negatively than those of other doctors.
“The income gap that stratifies much of society often stratifies the physician community as well,” a 2009 report on primary care from the Robert Graham Center concluded. “The ‘heart hospital’ side of a medical campus may have fountains and artwork, while the mental image of the primary-care offices is a necessarily full waiting room of a practice where physicians see 40 or more patients a day.”
Those differences help explain the country’s primary-care doctor shortage. They also make an impression on medical students like Reem Nubani, a 30-year-old student at Southern Illinois University interviewing for residency slots.
“It has this connotation that you don’t make much money or you’re not as smart,” says Nubani, who is considering primary care. “Sometimes I feel like it may be even harder in primary care because you still have to know a little bit about everything.”
When the White House launched its residency program, it wasn’t sure medical students would show up. In fact, they snapped up all 172 slots funded in its first year. “The thing we were really thrilled about is that all the positions were filled,” said Kathleen Klink of the Health Resources and Services Administration.
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