Ardis Hoven is an HIV specialist-based in Lexington, Ky. who, last month, became president-elect of the American Medical Association. Earlier this week, she learned of the Supreme Court decision the same way the rest of us did: from TV.
"I was in my home in Lexington and watching television," Hoven said. "Luckily I wasn't on CNN, so I didn't go through the back and forth."
Hoven was happy to see the news: The AMA has long supported the Affordable Care, even though doctors look to be split in their opinion of the law. While the law will take big steps toward expanding insurance coverage, Hoven cautions there are still big challenges for doctors ahead. We spoke Friday about the country's shortage of doctors, how she and others will "teach" new patients to use their health insurance and what role physicians play in team-based health care. What follows is a transcript of our discussion, lightly edited for clarity and content:
Sarah Kliff: What does the Supreme Court ruling mean for the AMA and the doctors you represent?
Ardis Hoven: The AMA has supported the health reform law since its inception. Our history is such that we have supported covering the uninsured along with an individual responsibility provision. This comes from the work we're doing every day, seeing patients. For us it means millions of the uninsured will have insurance coverage.
SK: What work remains to be done to prepare for the law, especially with ensuring we have a large enough workforce?
AH: The good news is a lot of people are going to get health insurance and access to prevention and wellness programs. That means their quality of life will get better. These patients, however, are new to the health care system. We're going to have to be doing a lot of work making sure that the best care is delivered in the most appropriate venue.
To get to the issue of workforce, that wasn't something created by the Affordable Care Act. The nation was facing a physician shortage well before the law, and that's something we need to deal with.
SK: What role do you see doctors playing in making sure that people are getting the right health care at the right place once the insurance expansion happens in 2014?
AH: On the short term, teaching patients how to use their health insurance is going to be a huge issue. We're going to have to work together, really with everybody, to teach people how to use prevention and what benefits are available to them. We want to work with our physicians, whatever practice their in, to manage a high volume of patients while also providing high quality.
SK: How much can be done to deal with the workforce issues we're facing? What challenges are there?
AH: Well, it takes 7 to 10 years to train a doctor. So this won't get fixed overnight. Having said that, even though we see medical schools opening and training more doctors, there's the issue of residency training. For years now there have been caps on residency slots [that Medicare will fund]. That's been somewhat prohibitive.
We know that those residency slots need to be increased in number. We'd also like to see other initiatives to increase funding, particularly to increase training in primary care fields.
SK: Speaking of primary care, I know that the AMA added two new primary care seats to its committee that recommends prices that Medicare should charge, the RUC. Why was that necessary and how does it change the committee's work?
AH: It provides balance. That's what we need. It recognizes the importance of primary care and the equal importance of the specialties. It's not so much that it was missing before, but the environment of health care has been evolving and changed. We wanted to recognize that so we could move ahead and get rebalanced.
SK: A lot of other medical professions, such as physician assistants and nurse practioners, have recently made pushes to expand their scope of practice without the supervision of a physician. What do you think of those efforts?
AH: It's imperative that we collaborate. The patients need that. We think that care must be delivered in a physician-lead team. There are appropriate roles for other health care providers, like nurse pracitioners and physician assistants. They all have the ability to function to their highest level within a physician-lead team.
SK: Why does it have to be a 'physician-lead team,' as you put it? Nurse practitioners make the case that they can provide equally good care without a doctor's supervision, sometimes at a lower cost.
AH: The physician has the potential and capability to manage the unexpected, something that might not go as predicted. And that's why you need a team. The physician is the highest trained, and the one who has to be in charge of the whole thing. I have worked with physician assistants and have a wonderful relationship. I've worked with nurse practitioners and we work collaboratively. But when there was an issue that needed something beyond the scope of the individual, I was the one managing that.