Casualties of health-care war

The National Health Care Workforce Commission is as obscure as commissions come. At this point, it is practically a commission only in name. The 15-member panel, named in September, has not a scrap of anything to show for its existence. More accurately, it has not a scrap on which to exist.

And therein hangs a tale of how health care for millions of Americans may be compromised by the ideological warfare over health reform.

Leading up to passage of the Patient Protection and Affordable Care Act, critics hyperventilated about ''a government takeover.'' They couldn't paint a darker picture of the consequences — long wait times for appointments, rationing, declining quality — awaiting under ''Obamacare.''

And yet long before the scorched-earth battle began, close observers of the system, from researchers to hospital and medical school administrators, were warning about a more insidious situation. Their point: The country doesn't need a government takeover to experience lengthening wait times and de facto rationing and erosion of quality. A rising scarcity of physicians, particularly primary-care doctors, is moving us along that path as surely as any government decree would.

Doctor shortages, already evident, would be vastly aggravated with the expansion of health coverage to 32 million of America's 50 million uninsured and as more senior citizens qualify for Medicare coverage.

Currently, there are about 954,000 working physicians in America. Slightly more than a third of them are in primary-care specialties, including pediatrics, internal medicine and family medicine. The projection is that to keep up with rising demand for health services, we will need 45,000 more primary-care doctors by 2020. Problem is, fewer and fewer students are opting to go into primary care, where they are guaranteed long work hours and lower pay than other specialties.

At the current rate of medical school graduations, the country will be short some 150,000 doctors in all specialties by 2025, according to the Association of American Medical Colleges. And even if medical schools churned out more graduates, there is another structural contributor to the shortages: Slots in residency programs, where new doctors gain hands-on training and experience, are not increasing fast enough to accommodate them.

You don't need imagination to appreciate the impact of a shortage when you are twiddling your thumbs in an overbooked doctor's waiting room. Or when you wait weeks for an appointment and get a brisk 15-minute encounter. Or when your doctor is flipping through your folder, catching up on your history as you recount your latest symptoms. A study by a health industry group last year said the national average emergency room wait was four hours and seven minutes — an eternity during which to reflect on your misery.

Massachusetts passed the nation's first comprehensive reform five years ago broadly expanding health coverage. Its experience is offering signal lessons about what happens when demand outstrips the supply of medical professionals. Fifty-one percent of internists and 53 percent of family doctors surveyed early this year said they were not accepting new patients. Wait times for appointments are long, an average 48 days to see an internist.

What do you call it when students are bypassing primary care, and doctors have too many patients on their hands to sign you up? Rationing by shortage of supply? Is it possible to receive quality care from a harried physician who doesn't have time to review your history from one visit to the next?

The national reformers were only too aware of the Massachusetts experience. They understood the structural nature of doctor shortages enough to include several measures to alleviate the problem. One of those measures was to create a standing commission of experts with specific responsibility to analyze shortages of medical providers, especially in primary care, to make recommendations and coordinate with policymakers and medical educators at all levels to increase the nation's supply of doctors and other health workers. None of this — not the factors contributing to shortages nor the creation of a panel to address a problem years in development — strikes me as grounds for ideological warfare.

President Obama asked for $3 million to get the National Health Care Workforce Commission up and running. But a Republican Congress is sworn to starve his reforms of any all implementation funds. And one casualty of the war will be a meager $3 million to figure out how to shore up our doctor-supply lines.