Massachusetts Universal Coverage Is Imbalanced Between Physicians, Patients

Massachusetts' health insurance law has had the"unintended consequence" of exacerbating the "imbalance"between supply and demand for primary care physicians, the NewYork Timesreports. Since the law took effect last year, about 340,000 of the state'sestimated 600,000 uninsured residents have obtained coverage. However, the numberof physicians in the state has not increased, leaving many newly insuredresidents "searching for doctors and scheduling appointments forlong-deferred care," and forcing physicians to take on additional patientsand reduce time spent with patients, according to the Times. The Timesreports that the "situation may worsen as large numbers of generalpractitioners retire over the next decade."

Patricia Sereno, state president of the American Academyof Family Physicians,said "It's a recipe for disaster," adding, "It's great thatpeople have access to health care, but now we've got to find a way to give themaccess to preventive services. The point of this legislation was not to getpeople episodic care." Jon Kingsdale, executive director for the Massachusetts Health Insurance Connector Authority, said he had not heard of majorproblems but acknowledged "the prospect of a severe shortage" aspatients shift from seeking care in emergency departments to physicians'offices.

National Trend

A "confluence ofmarket and medical forces has been widening the gap between the supply ofprimary care physicians and the demand for their services" in some ruraland urban areas across the U.S.,the Times reports. According to the Times,"Whether there is a national shortage of primary care providers is amatter of considerable debate," as "[s]ome researchers contend the U.S. has toomany doctors, driving overutilization of the system." However, "thereis little dispute that the general practice of medicine is under strain at atime when there is bipartisan consensus that better prevention and chronicdisease management would not only improve health but also help controlcosts," the Times reports. According to the American College of Physicians and AAFP, the aging population inthe U.S.will require 40% more primary care physicians by 2020.

David Dale, president of the ACP and former dean of the University ofWashington School of Medicine, said, "I think it's prettyserious," adding, "Maybe we're at the front of the wave, but thereare several factors making it harder for the average American, particularlyolder Americans, to have a good personal physician." According to the Times,the number of medical school graduates in the U.S. entering family medicinetraining programs, or residencies, has declined by 50% since 1997. There havebeen slight increases in the number of physicians training in internalmedicine, but the share of those residents who establish general practices hasdropped to 24% in 2006 from 54% in 1998, according to the ACP.

Meanwhile, a Government Accountability Office report released in February foundthat the number of primary care physicians per capita increased by 12% from1995 to 2005 -- more than double the rate for specialists. The report alsoshowed that there are fewer U.S.-trained physicians pursuing primary care, andthere has been rapid growth in the number of physician assistants and nursepractitioners. A. Bruce Steinwald, GAO director of health care, said there isnot a nationwide physician shortage, but the U.S. must overhaul thefee-for-service reimbursement system, which he said undervalues primary carewhile rewarding expensive procedure-based medicine (Sack, New York Times,4/5).

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