- - Wednesday, December 18, 2013


Yes, Virginia, America faces a doctor shortage. And Obamacare will only make matters worse.

Reports from the American Medical Association and the Association of American Medical Colleges estimate that we’ll be 91,500 to 130,000 doctors shy in the next decade of what we’ll need to care for our aging population. The National Center for Health Workforce Analysis says we’ll need an additional 20,400 primary care doctors alone. Meanwhile, the American Association of Colleges of Nursing anticipates a shortage of up to 1.2 million nurses over the next decade.

Obamacare will exacerbate the problem in several ways. Its reporting requirements will add an estimated 190 million hours of paperwork annually. The red tape “hassle factor” undercuts efficiency, taking time, energy and dollars away from patient care.

Additionally, Obamacare’s promise of “free” preventive services are bound to increase waiting times as 30 million to 34 million newly insured Americans try to book exams.

Many people will find ways around this. Some insurers, for example, are designing “concierge option” plans that will let enrollees directly engage the services of physicians for monthly cash payments.

Already, 5,500 concierge medical practices have been established, their growth fueled by monthly rates that seem like bargains compared with the premiums required by insurance plans offered through the Obamacare exchanges.

But less-fortunate Americans — especially those consigned to Medicaid by Obamacare — will be unable to avail themselves of such “skip the line” options. Instead, they will have to endure long wait times for specialists, treatments and procedures. This holds true for those who don’t qualify for Medicaid and wind up purchasing the lower-cost plans available through the exchanges. These plans are able to offer lower premiums because they require higher deductibles and have narrowed the networks of medical personnel and facilities that patients can use. Channeling more patients to smaller networks is bound to aggravate access problems.

In recent congressional testimony, Dr. Scott Gottlieb with the American Enterprise Institute reported that an Obamacare bronze plan in Florida provides access to only seven pediatricians in one county with 260,000 children. Dr. Gottlieb further cited a plan in New York City that had no gynecologists as well as a San Diego County plan with no access to a pediatric cardiologist. As more Americans lose their existing coverage and are dumped onto the exchanges, access-to-care problems will only intensify.

What about the claims that technology and workforce redesign can fix the physician shortage? That’s just happy talk, Virginia.

Sure, technology and new practice models, such as team-based care, can alleviate some pressure, but they will not be enough. Nor should Americans depend on Obama bureaucrats to come up with quick fixes.

Many of the “innovations” trumpeted by the administration are already widely used. Nurses are able to adjust medication based upon standing orders; pharmacists can administer vaccinations; many protocols have been changed to reduce unnecessary services; laparoscopic surgery is used when appropriate; and the use of “paraprofessionals” has expanded greatly.

But these “innovations” haven’t significantly reduced demand for health care workers.

Americans need doctors and nurses, and doctors and nurses need a new practice environment. They do not need more bureaucracy creating more unproductive paperwork. The viability of the health care system will require the education of more health care professionals, the removal of access barriers, increasing efficiency, and improving the practice environment.

Policy issues, funding needs and regulatory requirements create hurdles for implementing real solutions to the health worker crisis. No amount of technology or structural redesign can take the place of a sufficiently staffed health care sector.

So, Virginia, it looks like more and more Americans will not be able to keep the doctors they like, and they can expect longer waits to see their new doctors — that is, if they can find any doctors who are accepting new Obamacare patients.

Amy Anderson is a health care policy fellow at the Heritage Foundation and an assistant professor of nursing at the University of Arkansas at Little Rock. She holds a doctor of nursing practice in executive leadership.

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