U.S. faces 90,000 doctor shortage by 2025, medical school association warns
The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.
The nation's shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.
In addition to the growing and aging population, full implementation of the Affordable Care Act in all 50 states would increase demand for doctors as more people are covered by insurance.
But Obamacare's impact will be small — just 2 percent of the projected growth in demand, the organization said. The supply of doctors also will grow but not nearly as quickly as the need, officials said.
"An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand," Darrell G. Kirch, the AAMC's president and chief executive, told reporters during a telephone news briefing.
The organization called on Congress to raise the federal cap on slots for medical residents at teaching hospitals by 3,000 annually, at a cost it estimated would be about $1 billion per year.
The government provides its $40,000 share of the cost of training each U.S. physician — estimated at about $152,000 annually — via the Medicare program. Currently, those hospitals train 27,000 to 29,000 doctors each year.
In 2013, there were about 767,000 doctors practicing in the United States, according to the report.
Policymakers have debated the doctor shortage for years, with some arguing that certain types of doctors are clustered in cities and affluent areas, leaving rural and poor Americans critically underserved. The government runs programs to encourage doctors, especially primary care physicians, to practice in shortage areas. Some states help doctors pay off their medical school debt, which can run into six figures, if they agree to practice in underserved parts of the country.
In a 2013 paper in the journal Health Affairs, Linda Green, a mathematician who studies the health care system, argued that the projected shortage of primary care doctors may not occur. The move toward larger practices, which enable physicians to share support staff and office space, can allow them to take on more patients. And the increasing use of physician assistants and nurse practitioners will have the same effect, she wrote.
Warns America seeing 'shortages of critical drugs' Published: 01/31/2015
The new Republican Congress is unlikely to repeal the Affordable Care Act even after the GOP’s overwhelming victory in the 2014 midterms, with both medical and political experts agreeing that Americans must learn to live with Obamacare for a few years.
Many Republicans won their elections by criticizing the president’s expansive health-care scheme. But in reality, Obama would block any congressional attempt to rein it in, analysts say.
Dr. Lee Hieb, author of the explosive “Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare,” warned in an exclusive interview with WND that the consequences of the new law are already beginning to hit the American heartland.
“Just judging from my experiences in Iowa, we’re already seeing increasing shortages of critical drugs like Valium, which is needed to prevent seizures,” she said. “We’re running out of drugs to prevent tetanus infections in Arizona, and I’m even receiving reports about shortages of propofol, which is basically what is used to induce anesthesia during surgeries. And while things may be OK in the major metropolitan areas for a while, here in Iowa, the shortages and supply chain failures are already starting.”
Hieb’s personal experience is supported by reports from around the country of hospitals nationwide encountering shortages of critical drugs.
According to the American Society of Anesthesiologists, or ASA, in the past five years “the United States has experienced shortages of an array of vital anesthetic drugs such as propofol, succinylcholine, even epinephrine.”
An ASA survey from 2012 shows more than 97 percent of anesthesiologists have experienced a shortage of at least one anesthetic drug.
And the reports have become more common, she said.
“When you make life difficult for providers, you negatively affect the entire process down the entire line.
The Affordable Care Act imposes further regulatory and compliance burdens on both doctors and those who create medical equipment and pharmaceuticals. We’ve had these kinds of burdens for a long time, but Obamacare simply makes everything worse. It takes everything that’s been detracting from medical care and expands it.”
She said a requirement that details of every appointment be entered into “electric medical records” is sabotaging medical care.
Instead of doctors spending time with patients, they spend most of their time and effort in data entry. The records are then used by the government and insurance companies to ensure that patients are receiving what bureaucrats regard as the appropriate kinds of care. Doctors must follow this system to be paid.
The system especially hurts specialists, she said.
“Many specialists simply leave the profession either because they can no longer afford to practice or simply out of disgust,” she said.
Government and insurance company bureaucrats are not familiar with the patients and have no basis to determine what kind of treatment is required. The result is that doctors have more overhead and liability even as they are prevented from providing effective treatment.
Hieb said, “This electronic records requirement was the final nail in the coffin for me and pushed me to leave private practice.”
Obamacare strengthens such requirements and makes the government more involved in determining how medical care is to be provided. Other medical experts concur with Hieb that the Affordable Care Act is transforming the role of doctors from providers of medical care into “data entry clerks.”
In an interview by the medical industry publication Medscape, arheumatologist said: “Bureaucrats are telling us how to practice our profession, and they don’t have a clue about seeing patients on a daily basis. All the factors that made U.S. medicine the best in the world are now being destroyed.”
Little reason for hope from Congress
According to Hieb, “Obamacare is emptying out the heartland as far as medical care goes.”
The effects of the law are creating a political reaction as newly elected Republicans such as Sen. Bill Cassidy, R-La., report “a tide rising” against the Affordable Care Act from “all these angry people” forced to deal with the law.
But leading conservatives and political experts do not see much hope of a repeal or even a substantial rollback in the short term.
Renowned Republican strategist Richard Viguerie, author of the new book “Takeover: The 100-Year War for the Soul of the GOP and How Conservatives Can Finally Win It,” predicts that the new Republican Congress will disappoint conservatives by not repealing the Affordable Care Act.
Viguerie judges that many Republicans “don’t have the conviction or the political courage and a total repeal is not something high on their priority list.”
“Though I think we can chip away at it and weaken it, I’m not optimistic that GOP leaders are really honest when they say repeal and replace,” he said. “They are not prepared to fight Obama in the way that is needed.”
Similarly, Eagle Forum Founder and President Phyllis Schlafly says, “Many Republicans ran against Obamacare, and repealing it is clearly the sentiment from the grassroots.”
However, Schlafly believes the “Boehner Congress has not been willing to put up much of a fight.”
Viguerie thinks Republicans can eventually win the war over Obamacare after a long struggle.
“We need to defeat more RINO (Republican In Name Only) Republicans in the House particularly and keep up the pressure. And we have to make sure we nominate a Republican for president that shares our views, not an establishment Republican like a Jeb Bush, a Chris Christie or a Mitt Romney. We have to get a president that commits to repeal and replace Obamacare.”
Viguerie notes that many Republicans come to Washington with the best of intentions but are eventually co-opted. However, “one of the things we have now is a network that can keep the pressure on and support those Republicans who decide to buck the leadership. We didn’t have that 10 years ago.”
Still, such hopes hinge on a unified Republican government, which is at least two years away, and on conservative victories in the Republican presidential primaries and a sweeping election win in the 2016 general election. In any case, Americans will have to live with Obamacare for some time.
Furthermore, conservatives still have to confront the political reality that Republicans receive much of their money from corporate lobbyists.
Viguerie goes so far as to say “Conservatives need to understand that their No. 1 opponent is not Nancy Pelosi, Harry Reid or even Barack Obama.’
“It’s the Chamber of Commerce. Even the best of these young conservatives get 75 percent of their funding from K Street and corporate lobbyists,” he said.
When it comes to the Affordable Care Act, some of the biggest stakeholders donating to the Republican Party are insurance companies that enthusiastically support the new legislation.
For that reason, Hieb is pessimistic even in the long term. She says wryly that a repeal would be proof that “the age of miracles is not yet over.” But she believes most voters won’t understand the implications of the Affordable Care Act until they personally experience the coming shortages and restricted care.
Yet another doctor has decided to quit practicing medicine due to Obamacare’s onerous burdens.
“I am in my mid-70s and have both the capacity and willingness to care for patients for another decade. But I am retiring,”
Dr. John Curry of Fairfax, VA, wrote to one of his patients, columnist Cal Thomas, in an explanation of how the Affordable Care Act (ACA), more commonly known as Obamacare, is leading him to retire early.
“I cannot stand it anymore. More than half of my time in the office is spent filling out forms, writing letters, responding to inquiries, and attending to ‘urgent’ matters that did not exist 10 years ago.
And every year my income is less,” he wrote. “At this point I would rather be paid nothing and have the freedom to decide what is right for my patients.”
“ACA is only another straw, but for this tired camel, it will break my back,” wrote Curry.
This is consistent with The Deloitte Center for Health Solutions survey of more than 600 physicians, which found
“Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next one to three years.”
Curry emphasized that Obamacare will make medicine far more impersonal, reduce choice, and significantly increase costs:
The monstrosity has been birthed, and soon you will look in vain if you are seeking a personal physician who knows you, cares about you, and to whom you have ready access. You will find only systems, ready to suck you up, give you a number, and provide you with federally approved accountable care in a sterile environment populated by highly regulated strangers. And it will cost you a lot! (Whatever anyone says, prepare for a future where your health costs will be higher and your choices fewer!)
As Thomas explains, the country can’t afford to lose good doctors like Curry, but having fewer doctors is one of many side effects of Obamacare. While a physician shortage was predicted before Obamacare, too, the law just makes things worse. The American Association of Medical Colleges estimates the U.S. faces a shortage of 91,500 physicians by 2020.
Over 214,000 Doctors Opt Out of Obamacare Exchanges October 28, 2014
Over 214,000 doctors won't participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows.
That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It's also about a quarter of the total number of 893,851 active professional physicians reported by the Kaiser Family Foundation.
In January, an estimated 70% of California's physicians were not participating in Covered California plans.
Here are some of the reasons why:
1. Reimbursements under Obamacare are at bottom-dollar - they are even lower than Medicare reimbursements, which are already significantly below market rates. "It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60," a study by the think-tank American Action Forum finds. "For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California's Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent."
2. Doctors are expected to take on more patients to make up for the lost revenue, but that's not happening because primary care doctors already have more patients than they can handle. "Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the PCPs time at lower pay," says the study.
The study also points to two reasons that doctors might not get paid at all:
3. An MGMA study indicates that 75% of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they will get stuck with the bill.
4. HHS requires that insurers cover customers for an additional 90 days after they have stopped paying their premiums: the insurer covers the first 30 - but, it's up to the doctor to recoup payment for the last 60 days. This is the number one reason providers are opting to not participate in the exchange plans. Currently, about a million people have failed to pay their premiums and had their plans canceled.
So, Obamacare is asking doctors to take on sicker patients for less money, with the risk of not getting paid at all? No wonder doctors are running from these plans!
DOCTOR SHORTAGE: HOW OBAMACARE MAKES IT HARDER TO FIND A DOCTOR
Remember how Obama promised that if you liked your doctor, then you could keep your doctor? It turns out that there is more to making policies than just saying what you’d like to do in a scripted campaign speech. The truth is that some health care policies will make you lose your doctor, regardless of what the President reads off of a teleprompter. Is Obamacare one of these policies? Let’s see.
Avik Roy writes about it in Forbes magazine.
Excerpt:
On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.”
The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years.
[…]Over the next ten years, Obamacare was designed to spend around $1.9 trillion on expanding health coverage to the uninsured. The law pays for this new spending with $1.2 trillion in new taxes, and $716 billion in cuts to Medicare, relative to prior law.
[…]The private insurers who supply Medicare Advantage plans, like UnitedHealth and Humana, have been responding to the cuts by squeezing out inefficiencies in the way they deliver care. One obvious way to do that is to pay doctors and hospitals less—or kick out the providers who refuse to accept lower reimbursement rates. And that’s what United has done, according to the WSJ report from Melinda Beck.
“Doctors in at least 10 states have received termination letters, some citing ‘significant changes and pressures in the health-care environment,’” writes Beck.
Another one of my favorite health care policy experts is the ex-Canadian Sally C. Pipes, who knows all about the horrors of single-payer health care. It killed her mother! Here’s what she had to say about the doctors' shortage in a Forbes magazine article from earlier this year.
The first problem is that we have an aging doctor population and since we do such a poor job of educating our children (public school indoctrination centers) we aren’t making any new ones:
Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. (11/19/2013) The shortage could quintuple over the next decade, thanks to the aging of the American population — and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.
The second problem is that adding more regulations and burdensome paperwork makes a lot of people not want to be doctors any more: Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.
The third problem is that the government isn’t reimbursing doctors as much as private insurance companies do, and it makes them refuse to take government-funded patients:
They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.
Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.
These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn’t increased payments to doctors in three years; Kentucky hasn’t raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.
By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.
It’s not just Medicaid that’s the problem, either. It’s the government-controlled exchanges.
Healthcare providers are signaling that they may turn away patients who purchase insurance through the exchanges, too.
In California, for example, folks covered by Blue Shield’s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.
Now I know what you’re thinking – why not just force doctors to work for lower wages, like a good socialist country might? Well, that actually makes the shortage worse, because people don’t like to learn hard things and then work hard for little pay. And doctors work VERY hard – it’s not an easy profession to get into. That will just make all the doctors leave the country for other countries where they can be paid fairly for the work they do.
And in fact that is exactly what happened in a 100% socialized health care system in Venezuela, according to this report from the left-leaning Associated Press.
Excerpt:
Half the public health system’s doctors quit under Chavez, and half of those moved abroad, Natera said.
Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.
At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.
I recommend reading that entire article for a glimpse of where the Democrats are trying to take us. There is not a dime’s worth of difference on policy between the Democrat party and the socialist party of Venezuela, except that the socialists have been in control in Venezuela for longer, and so they are further along the road to serfdom.
In other news, the Washington D.C. insurance commissioner was fired after raising concerns about the “fix” proposed by Obama in his speech last week. That’s also something that you might expect to see in a country like Venezuela. That’s what happens in authoritarian socialist countries. Whistleblowers and critics just disappear.
Patients are waiting an average of 18 days to schedule an appointment for a doctor, according to a study of appointments for commonly used specialty physicians in 15 major U.S. cities. The survey by physician staffing and consulting firm Merritt Hawkins comes as a doctor shortage looms as more patients seek medical care under the Affordable Care Act. The health law is bringing millions more Americans health benefits and therefore the ability to pay for a visit to the doctor’s office.
The longest wait to see a doctor was in Boston where the average wait was 45.5 days to schedule an appointment with a family physician, dermatologist, cardiologist, orthopedic surgeon or obstetrician/gynecologist. The survey came from a sampling late last year of nearly 1,400 medical offices across the country.
“In the next two to three years, can we keep a bad situation from getting worse?” asked Travis Singleton, senior vice president at Merritt Hawkins, a subsidiary of AMN Healthcare (AMN). ”Everything will tell you it’s going to get worse and not better.”
The increase in doctor wait times to this point isn’t completely related to the health law. The improving economy is also driving more Americans to the doctor’s office. In recent years, data has showed slow growth in visits to doctor’s office during a period of high unemployment as well as the trend for insurance companies and employers to increase co-payments and deductibles. “Finding a physician who can see you today, or three weeks from today, can be a challenge, even in urban areas where there is a high ratio of physicians per population,” said Mark Smith, president of Merritt Hawkins. “The demand for doctors is simply outstripping the supply.”
When health care coverage is expanded and there is more access to physicians, wait times rise.
Take Boston, which has a high number of “physicians per capita,” Singleton said. “Yet they still have the longest waits for appointments.”
Massachusetts has had broad health care coverage for most of its residents for several years now and the state’s law was the model for the Affordable Care Act.
“People are accessing the system (in Massachusetts) at greater and greater levels,” Singleton added.
There is, however, good news for appointment times as health care reimbursement moves away from fee-for-service medicine to value-based care that emphasizes the use of accountable care organizations and patient-centered medical homes.
In ACOs and other models, doctors are handing off more responsibilities to physician assistants and nurse practitioners with the physician as more of a quarterback of sorts.
Medicare and most private insurers like those operated by Aetna, Cigna, Humana, UnitedHealth and most Blue Cross and Blue Shield plans are linking with ACOs, which push high quality, less expensive care rather than today’s payment system that often leads to excessive care by paying for each treatment or procedure that isn’t always better.
The providers in an ACO are responsible for managing the care of the health plan enrollees and are financially rewarded if the enrollees, or patients, stay out of the more expensive hospital.
“We are much better at managing the health care system and using nonphysicians,” Singleton said. “We are much better at using nurse practitioners and physician assistants.”
Cities with the Longest Doctor's Appointment Wait Times
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