Considering the Provider Side of the Healthcare Equation

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The Physicians Foundation has released a report chronicling the growing frustrations of primary care physicians in America. The report indicates that as many as half of the nation’s primary care Family Medicine and Internal Medicine doctors may consider quitting in the next three years.

Why? The answer is pretty simple: too much bureaucracy.

There is already a shortage of primary care physicians in the U.S. and the problem is likely to increase:

[M]ed school students are shying away from family medicine. In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That’s because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness.

The costs of running a practice are high and insurance payments for many routine procedures continue to decrease, thanks in a large part to the decreasing payouts from Medicare and Medicaid whose payment structure private insurance companies often emulate. In fact, Medicare and Medicaid are becoming such money losers for physicians that:

[O]ver a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients.

Here’s the part where I talk about national health care plans (you knew this was coming). One of the biggest challenges in designing a national insurance plan is figuring out how to spread limited resources over a larger population without significantly raising costs OR pushing providers to quit or move to a private pay system where they treat only those willing to pay cash (i.e.: the wealthy).

If we’re already short on primary care doctors and a third of those are already declining Medicaid, how on earth will we get enough providers to participate in the new system without significantly raising payouts to entice and retain primary care doctors? And if we raise payouts, that increases the overall costs associated with the healthcare system.

Or we could just cross our fingers and hope it all works out. Unfortunately, that seems unlikely given that the current healthcare market, in its heavily regulated non-free-market form, is already failing to create the incentives necessary for a strong base of primary care providers. Would placing more regulations and more layers of bureaucracy really improve the situation?

If President-elect Barack Obama wants to provide universal or near-universal healthcare, he and Congress must consider the effect their plan will have on providers. Generally, physicians are just as jerked around by the insurance system as are their patients. Their concerns should also be just as relevant. Any national healthcare system has to find a way to make primary care a reasonable and profitable option for physicians, or we’ll have a massive shortfall of providers. And that won’t benefit anyone.