As ACA insures more Americans, doctor shortage looms

Miller sees her doctor
Mary Miller, who has lived with diabetes for some 68 years, visits with Dr. Elizabeth Seaquist at the University of Minnesota in December 2011.
MPR Photo/Lorna Benson

Once the Affordable Care Act is fully implemented, there will be 32 million more Americans covered by health insurance. The question now is: Who's going to provide medical care for all of them?

The medical community — already concerned about the primary care doctor shortage — is warning that longer waits for appointments, crowded emergency rooms and pressure to train new physicians is likely. There is also a future nursing shortage predicted, with waves of retirements in the coming years.

Dr. David Troxel, a clinical professor emertius at University of California Berkeley, said this influx in patients will hit as the system is already dealing with an aging population. He said the shortage of doctors will hurt patient care:

Primary physicians who practice in groups are typically expected to see four patients per hour — one every 15 minutes — and this number will likely increase due to cost and productivity pressures to wring even more work from fewer doctors. Unfortunately, this trend will be accompanied by continued downward pressure on their incomes. Few physicians are earning as much today as they did even five years ago, and primary-care physicians have been affected more than specialists in this regard. Additionally, the shift from a fee-for-service to a bundled fee-for-performance reimbursement system — while still in transition — will lead primary-care doctors who practice solo or in small groups into larger group practices.

But others say the growing and aging population is more to blame for the shortage than the newly insured. Don Kusler, executive director of Americans for Democratic Action, wrote about the shortage for The Denver Post:

MPR News is Reader Funded

Before you keep reading, take a moment to donate to MPR News. Your financial support ensures that factual and trusted news and context remain accessible to all.

As a study published by the Annals of Family Medicine last year determined, population growth and population aging over the next dozen years will cause 85 percent of the increased need for physicians. Expanded access to medical services offered by the ACA — which we should all agree is a good thing — is responsible for just 15 percent of the shortfall.

In other words, even if we hadn't reformed the health system to give 30 million previously uninsured people access to timely, economical medical care, we would still need a lot more doctors to care for a country that's getting bigger and older all the time.

Nurse practitioners are qualified to take care of many patient needs that physicians currently handle and could "help fill the gap but often are kept from practicing to their full authority because of procedural red tape," wrote Sarah Gantz for the Baltimore Business Journal:

The institute's report said that state laws themselves do not restrict what services nurse practitioners can provide but the laws can indirectly affect nurse practitioners' ability to practice. Considering the big demand for primary care services analysts are predicting, states might want to adjust their regulations to more explicitly define nurse practitioners as primary care providers, the report concluded.