No Doctors, no Reform

Health care reform in the United States keeps tripping over one fact: We don’t have enough Primary Care Physicians, or PCPs. The PCPs are your “family doctors,” the M.D.’s who aren’t specialists. Really, they specialize in the entire body, providing all types of care and referring to a true specialist when needed. And we don’t have enough of them. In fact, we’re doing as well as we are because the older doctors who are in Primary Care are still working.

No matter what kind of incentives, bonuses, or recruitment tools you offer, there is no quick fix for this problem. Medical school and residency requirements mean that even if you could wave a magic wand and make being a PCP the most attractive medical job in the world, it would still take eight to ten years for the new M.D.’s to start flowing into the system. So we’re going to be here for a while. There’s a proposal – not an official one, but more like a “Wouldn’t it be nice if…” idea – to offer more training to Nurse Practitioners (NPs) and allow them to take on the responsibilities of a Primary Care doctor.  The Happy Hospitalist says no way: NP does not equal PCP, not even close.

So what’s causing the shortage? Debt. When the average doctor knows that he’ll graduate medical school owing $150,000 or more in student loans, who can blame him for specializing? Especially when you know that Medicaid pays 20% to 30% less than what Medicare will pay, and less than half what a private insurer would pay? “In God we Trust, all others must pay cash,” the old saying goes and you can bet that debt collection agencies know that verse very well. No wonder nearly half of all doctors won’t see a patient with Medicaid/Medicare.

So if you think you can “fix” the Healthcare system,  here’s a good place to start.

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