The United States needs 16,000 more primary care physicians to meet its current health care needs, a problem that will only get worse if nothing is done to accommodate millions of newly-insured residents under President Obama’s health care law in the coming decade, according to a Senate report released Tuesday.
Sen. Bernie Sanders, Vermont Democrat and chairman of the Subcommittee on Primary Health and Aging that released the findings, said one in five sick Americans visits an emergency room for care that should have been rendered by a primary care physician, an unfortunate trend that results in higher health care costs and poorer outcomes for patients.
The lack of primary care offices hits rural regions and low-income urban areas the hardest, and will turn into a crisis if lawmakers and the industry do not address the problem before the Patient Protection and Affordable Care Act expands coverage to 30 million more Americans, Mr. Sanders said Tuesday at the outset of a hearing on the topic.
Medical school graduates have been flocking to lucrative specialty fields that will pay nearly $3 million more than primary care positions over the course of their careers, an attractive option to students who face an average of $160,00 in debt after medical school, Mr. Sanders said.
“In simple terms, a specialist will make twice what a generalist makes … That is a huge problem,” Fitzhugh Mullan, a professor of medicine and health policy at George Washington University, testified before Mr. Sanders’ subcommittee on Tuesday.
Mr. Sanders’ said some of the blame appears to rest with a board of 31 physicians who make reimbursement recommendations to the Centers for Medicare and Medicaid Services (CMS), which private insurers frequently adopt as well.
The American Medical Association’s Relative Value Scale Update Committee, or RUC, is populated by many more specialists that primary care physicians, multiple witnesses said Tuesday.
“Therefore, it should come as no surprise that it has accelerated higher payments — larger paychecks — to specialists over primary care doctors,” Mr. Sanders’ report said.
In response, the AMA noted that two primary-care seats were added to the group last year.
The RUC’s chairwoman, Barbara Levy, said in an emailed statement they are “an independent group of physicians from many specialties, including primary care, who use their expertise on caring for Medicare patients to provide input to CMS.”
Mr. Sanders said United States’ ratio of primary care doctors to specialists, at 30 percent to 70 percent, is out of sync with that of other countries.
And while the nation spends twice as much per capita on health care as any other country, “our health care outcomes — in terms of life expectancy, infant mortality and disease prevention — are not particularly good in terms of international comparisons,” Mr. Sanders said at the hearing.
Sen. Chris Murphy, Connecticut Democrat, said medical students tend to see primary care as less groundbreaking or prestigious than specialty fields, and Mr. Mulligan said professors tend direct brighter students toward specialty care.
“That culture is toxic,” the professor said, “and it’s out there and we need to worry about it.”