Physician Shortage Will Stop Universal Health Insurance Dead in Tracks

Doctors and universal health insurance coverage

Senator Barack Obama wants to provide universal health insurance coverage to all Americans, but the physician shortage will stop it dead in it’s tracts. With less than 2% of medical students choosing primary care medicine as a specialty and the aging physician population that is ready to retire within the next five years, we have a crisis looming.

There is already a shortage of primary care physicians and physicians in some basic specialties like general surgery, neurology and rheumatology. Even large metropolitan areas are lacking in gerontologists and family physicians and rural communities are also challenged. It is these physicians who manage 80% of all health care needs of our population and who keep costs under control by knowing the patient and providing continuity and preventive care. As they retire or close their practices to new patients, there are no young physicians to take their place.


Young physicians in training are turned off by the enormous unsatisfying paperwork and difficult practice environment of primary care. Our reimbursement system has disadvantaged these physicians for years and they are at the bottom end of the income scale, despite the fact that they are the basis for a healthy population. Primary care doctors spend more time talking with patients and managing health care without expensive procedures and tests. The reimbursement for these cognitive services are not keeping up with the costs of running a practice and young doctors are walking away from this type of practice in favor of better lifestyles and more pay.

Even medical strongholds like Boston, Mass., where there are several academic teaching hospitals and wonderful medical care, there is such a shortage of primary care physicians that doctors and nurses can’t find a doctor to care for their own family. Finding a good primary care physician requires “knowing someone” who can open the door for you to be seen as a patient.

The proposal to provide health insurance for the 45 million Americans who are presently uninsured will fall flat unless we address this critical issue of primary care and who is going to take care of people. Having insurance is not the same as having access to care.

Episodic, expensive, high-tech, specialty services have created a monetary health crisis that looms larger than the banking meltdown. It is time we look at the primary care crisis and begin finding solutions that will allow health care reform to succeed. Without considering the primary care piece, the idea of universal health insurance coverage is doomed to failure.



You are, of course, correct in your analysis. Any solution needs to concentrate on the provider side of the problem, not just assume that more money added to the system will do anything more than just cause a general price increase leaving us where we currently are, but just more expensive.
The 'enormous unsatisfying paperwork' of primary care is caused by the HMO insurance system, that bleeds 31% of the total cost, an order of magnitude greater than administrative diversion under government-run systems.
As an undergaduate, and now as a medical student I have been trying to spread this same message, but no one seems to care because they don't understand the underlying issues! This article is dead on target! To add to this, there needs to be more spots opened up at medical, nursing, and healthcare professional schools as well. With some medical schools getting 10,000-13,000 applicants for <200 spots there will be enough physicians in any field to care for the current population that has insurance, and the 40+ million on top of it. Allof our politicians and citizens need to recognize this problem before we are allowed to provide more comprehensive and complete healthcare to everyone.,
The system needs to change a bit via boosting and expanding Nurse practitioners and Clinical Pharmacist take more care in a particular primary care speciality and prescribe medications and do things same as primary care physicians do. Victor Forlacino Rph.
We must act and now. This is an urgent and vital issue for most people. Nurse practitioners and Clinical Pharmacists can be part of the solution as members of a team lead by Primary care physicians, but they cannot be the solution.