Punch line: According to honchos from Johns Hopkins and Emory Med Schools, health insurance doesn’t guarantee health care — we need initiatives to boost the ranks of physicians and make all physicians more productive.
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Excerpted from Baltimore Sun Times: Prescription: more doctors, January 1, 2010
That 30 million Americans may soon be able to obtain health care insurance is at the core of the Senate and House health care bills.
But let’s be clear: “insurance” doesn’t guarantee “care.”Indeed, the legislation is giving “bus tickets” – that is, health insurance – to uninsured Americans. But there are no buses running on those routes.
Without important changes in how many doctors we produce and how we pay to train them, millions of newly insured Americans will simply not have access to a physician.
In fact, we don’t have enough doctors for the 256 million Americans who are insured right now.
The U.S. Department of Health and Human Services notes that the United States has a current shortage, at minimum, of 16,000 primary care physicians.
Some facts:
The U.S. medical schools train about 27,000 new doctors a year.
Today, the overall number of physicians in the U.S. is lower than the average per capita number of doctors in other nations such as Sweden, Denmark, Spain and France, and we now “import” some 25% of our physicians from other countries.
According to HHS, overall demand for physician services will increase an estimated 22% between 2005 and 2020, and the United States will face a shortage of more than 125,000 physicians in the next 15 years.
http://online.wsj.com/article/SB10001424052748703483604574630321885059520.html?mod=djemEditorialPage
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The solution is to increase the supply of physicians, especially those in primary care and general surgery … and to increase Medicare-funded residency slots for physicians.
Already, the nation’s medical schools have pledged to increase enrollment by 30 percent by 2015.
Training slots for residents have been capped at present levels for more than a decade.
An increase of 15,000 positions would produce an additional 40,000 physicians over the next 10 years, helping the nation manage the projected shortage by 2025 of 125,000 physicians. And unless we significantly expand training positions, the number of physicians per capita will begin to decrease in the next 10 years.Moreover, there are other steps we can take:
Double the number of National Health Service Corps awards.
Under this program, medical school tuition is paid off by physicians agreeing to practice for several years in underserved areas.
This would not only help with the supply issue, but the more persistent problem of how doctors are distributed around the country. There are plenty of physicians in high-income ZIP codes in the United States. The shortage is most acute in rural areas where access is difficult and where the poverty level is high.
Changing doctors’ traditional practice model.
Nurse practitioners and physician assistants should be more fully integrated into clinical practice, handling the simple, uncomplicated cases. This would allow the physician to spend more time managing patients with chronic and complex conditions.
The new best-practice model should include designing a “medical home” for all patients, utilizing – and paying – all health professionals as part of team that coordinates care, enhances efficiency and increases patient satisfaction.
Cutting through the “hassle factor” of medical administrative costs.
An in-depth survey published in the journal Health Affairs in May showed physicians spend an average of three hours a week on the phone or corresponding with insurance claims adjusters.
Nowhere addressed seriously in House and Senate legislation are the paperwork and multiple insurance claim forms that many physicians name – along with other administrative issues – as their No. 1 complaint.The cumulative cost of the time physicians spend interacting with insurers is $23 billion to $31 billion annually – money and time that could be better spent on direct patient care.
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As the House and Senate conferees refine legislation promising new benefits to 30 million Americans, we trust that, unlike the bus tickets to nowhere, attention is focused on funding and training a health care workforce that guarantees access to all.
Dr. Michael M.E. Johns is university chancellor and professor in the schools of Medicine and Public Health at Emory University. Dr. Edward D. Miller is dean and CEO of Johns Hopkins Medicine.
Full article:
http://www.baltimoresun.com/news/opinion/oped/bal-op.doctors01jan01,0,7827816.story
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