Actually, my title is a bit misleading. Not everyone has coverage…many people have not complied with the new law mandating coverage, and simply pay the fines. So the state still has many uninsured people, and now it has a rising shortage of primary care physicians.
Those of us who have taken a basic economics course saw this all along…but the politicians running on a “universal coverage” platform (I won’t name names), were quick to ignore common sense in an effort to push deficient legislation through the pipeline to deliver on their promise to the people. We probably have sound-bite culture to thank for this gem.
Here’s a quote from Dr. Katherine Atkinson, a primary care physician in Massachusetts: “I calculated that every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave. I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?” The quote comes from a recent New York Times article which highlights the growing shortage of primary care, the increasing wait times and travel distances to see a doctor, and the resulting reduced access to care.
The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.
Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.
Dr. Atkinson, whose present insurance reimbursements don’t even cover her costs, doesn’t have an opening for an appointment until May of 2009.
Here’s another excerpt from the article:
Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.
“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”
Primary care, research shows, is at the core of quality health care. This is the preventative medicine, counseling, and monitoring aspect of medical care that helps patients stay healthy and prevent the need for expensive specialty care, presumably because they will have less chronic disease if they actively manage their health, rather than go to an emergency room when a problem is so big it can no longer be ignored…
The new law of forced coverage it working to effectively end primary care in its present form in Massachusetts.
Bart,
Perhaps you might be interested in a recent post of mine on the subject.
Best,
Paul
There are undoubtedly big problems with the MA plan, but the blame cannot be on the state for a shortage of primary care physicians. Not enough primary care physicians? That isn’t a terribly difficult problem to solve. Yes, we can have more medical schools without crushing the system or destroying doctor paychecks. Graduates of the highest regarded schools will still be first in line for residencies in the highest-paying specialties. A few more schools at the so-called bottom can produce more primary care physicians.
i’m not blaming the state for the shortage…i think this is more about short-sighted legislation that has more style than substance. you can’t just require people to buy insurance and solve any of the underlying causes of the problems. i think the Patriot Act is another example. everyone jumped on the “protect the country from terrorists” bandwagon and didn’t ask enough of the initiative before signing off on it. many voting members of Congress didn’t even read it. same with Sarbanes-Oxley and the ensuing drama after the Enron scandal. I’m fearful new, hasty regulations will materialize out of the latest housing debacle.
health care is clearly complicated…the unintended consequences of “coverage for all,” i think, might resemble those of a cancerous lesion with some Neosporin and a Band-Aid.
and if Grand Caymen’s finest medical school can increase capacity and supply the state of massachusetts with enough PCP’s, that’s great.