The Affordable Care Act presents many good news/bad news scenarios, as would be expected with the overhaul of a system as complex as health care. The good news, in part, is that the law will enable at least 30 million people to gain coverage when the provisions for health exchanges and an expanded Medicaid go into effect in 2014. The bad news, as Census data and surveys by medical associations indicate, is that the nation does not have a physician work force large enough to meet the increased demand for medical services.
Expanded access under the reform law exacerbates a problem that is quite evident already. With the population growing and the baby-boomer generation entering its senior years when use of medical services rises, the Association of American Medical Colleges, among other groups, has been warning about a shortage of doctors across all specialties, more acutely in primary care, which includes pediatrics, family and internal medicine and general surgery. Of the nation’s physician work force, an estimated one-third are 55 years or older and close to retirement. In Ohio, about 21 percent of doctors are 60 years or older. According to the medical association’s projections, the nation will be short nearly 63,000 doctors in 2015. The estimate is expected to double by 2025. Roll back the reform law, and the nation still will be short some 100,000 doctors by 2025.
With funding cutbacks and a federal freeze on residency training positions, medical schools and teaching hospitals lack the capacity to produce enough doctors fast enough to meet the immediate need, even with the recent increase in medical schools. It is crucial to raise the output of medical school and fund more residency training slots.
Equally urgent is the need to put in place measures that will alleviate the immediate impact of doctor shortages, for instance, expanding the range of primary-care functions nurses can perform and scaling up the medical-team approach central to accountable-care programs. It will be cruel if Congress allows the good news of health coverage to turn sour because patients face lengthy delays for care, a problem long evident in underserved rural communities and inner cities.