Has Obamacare Worsened the Primary Care Physician Shortage? - DEBATED


General Reference (not clearly pro or con)
Linda V. Green, PhD, Armand G. Erpf Professor of Business at Columbia Business School, Sergei Savin, PhD, Associate Professor at the University of Pennsylvania, and Yina Lu, PhD, Associate at Goldmans Sachs, stated the following in their Jan. 2013 study "Primary Care Physician Shortages Could Be Eliminated Through Use of Teams, Nonphysicians, and Electronic Communications," published in Health Affairs:

"Our study demonstrates that as health systems are increasingly confronted with pressure to contain costs while improving access and coordination of care, the use of primary care physician pools supported by nonphysician professionals and electronic health records can be an efficient and effective approach to increasing patient panel sizes without compromising access. Given the current trends toward adoption of these practices, the widely perceived national primary care physician shortage that has been forecast may, in fact, be greatly overestimated."




PRO (yes)

The Association of American Medical Colleges stated the following in its Mar. 2015 report prepared by IHS Inc., "The Complexities of Physician Supply and Demand: Projections from 2013 to 2025," available at www.aamc.org:

"Projected shortfalls in primary care will range between 12,500 and 31,100 physicians by 2025...

Expanded medical coverage achieved under ACA once fully implemented will likely increase demand by about 16,000 to 17,000 physicians (2.0%) over the increased demand resulting from changing demographics. The Congressional Budget Office estimates that 26 million people who otherwise would be uninsured in the absence of ACA eventually will have medical insurance. Taking into consideration the health and risk factors of the population likely to gain insurance and estimated changes in care utilization patterns associated with gaining medical insurance, the projected increase in demand for physician services is about 2.0%. The increase is highest (in percentage terms) for surgical specialties (3.2%), followed by primary care (2.0%), medical specialties (1.7%), and 'all other' specialties (1.5%)."




The American College of Physicians (ACP), in a statement by its President David A. Fleming, MD, MA, stated the following in its July 31, 2014 article "American College of Physicians Reacts to IOM Report," available at the ACP website:

"[W]e believe there is credible evidence of a real and growing shortage of primary care physicians for adults warranting immediate action. It is estimated by highly credible analyses that the nation will need 44,000 – 46,000 additional primary care physicians by 2025. This figure does not take into account the increasing demand for primary care services as an estimated 25 million uninsured Americans will obtain coverage through the reforms in the Affordable Care Act."




Massachusetts General Hospital stated the following in a Jan. 6, 2015 press release "Primary Care Physicians More Likely to Recommend Careers as Nurse Practitioners Than as Physicians," available at its website:

"The continuing shortage of primary care physicians is expected to only worsen, as the expansion of health coverage under the Affordable Care Act increases the demand for primary care services. Recommendations for meeting the crisis have included both increasing the supply of primary care physicians and expanding the roles of primary care nurse practitioners."




David Holden, MD, practicing orthopedic surgeon, stated the following in his Jan. 27, 2015 article "Office Visit: Primary Care Exodus," available at mcboh.com:

"Young people who do pursue medicine are gravitating to specialty medicine – neurology, gastroenterology, radiology, orthopedics, etc. They bypass primary care medicine because of patient overload, existing care guidelines and poor reimbursement rates...

The U.S. Department of Health and Human Services is expected to double its capacity to 40 million patients by 2015 due to Obamacare, so it's enticing medical school graduates to trade debt for service. It's offering doctors who will work in their community health centers the option to repay loans up to $120,000 in return for four years' service.

The new health care law was designed to connect patients with providers. Yet nearly one in five Americans live in regions where primary care physician shortages are significant. Consumers are calling multiple providers in their networks only to be told selected physicians aren't taking new patients. Despite efforts in many states to mandate insurance companies to increase the number of doctors and hospitals in-network, most Obamacare plans continue to have restricted networks and offer fewer doctors than before the health care overhaul.

The United States is facing a supply-and-demand crisis of epic proportion. It may be time for parents to begin promoting primary care medicine to their toddlers now, so there will be someone available to take care of their own generation in the future."




Sally C. Pipes, President and CEO of the Pacific Research Institute, stated the following in her May 6, 2015 article "Sally Pipes: ObamaCare Will Make US Doctor Shortage Worse," available at the Investors website:

"Need to see a doctor? It might take a while, thanks to Obama-Care...

[B]y expanding coverage and therefore demand for care, Obama-Care has actually exacerbated the existing shortage of primary care physicians. That's made it more difficult for many Americans to secure high-quality health care...

From 2013 to 2014, the law increased the number of low-income patients covered by Medicaid and the Children's Health Insurance Program by more than 9 million. As of March 2015, 8.8 million people had bought insurance through HealthCare.gov and 2.9 million had bought it through state exchanges. Another 2.3 million adults under the age of 26 have been able to stay on their parents' health plans.

These folks may have health insurance now. But that doesn't mean they can actually get care from a doctor."




Paul Howard, PhD, Director of the Manhattan Institute Center for Medical Progress, stated the following in his June 2013 report "The Obamacare Evaluation Project: Access to Care and the Physician Shortage," available at the Manhattan Institute's website:

"Our analysis indicates that population growth, demographic changes, and an expansion of insurance spurred by Obamacare will contribute to a significant shortage in primary-care physicians over the coming decade. We project that by 2025, the United States will experience a shortage of roughly 30,000 primary-care physicians—with about 16.5 percent (4,950 physicians) of this shortage being driven by the expansion of insurance coverage under Obamacare, while the remaining 83.5 percent (25,050 physicians) will be due to population growth, aging, and various demographic shifts."




CON (no)

The Commonwealth Fund, in a report by Sherry Glied, PhD, and Stephanie Ma, stated the following in its Feb. 2015 report, "How Will the Affordable Care Act Affect the Use of Health Care Services?," available at its website:

"Most earlier analyses assumed that the primary care physician supply is currently fully utilized, so that new demand would require new resources to maintain access to care. But newer research demonstrates that the intensity of health service use varies considerably across the United States...

Our analysis indicates that the ACA is expected to result in roughly 20.3 million additional primary care visits nationally, with people newly insured through the marketplaces accounting for more than a third of these visits, or about 3.8 percent above base...

The U.S. health system is likely to be able to absorb these increases. Use of primary, emergency, inpatient, and outpatient care varies substantially across the country, and these variations do not appear to be correlated with delays in access to care. The variation in use patterns supports the idea that anticipated increases in doctor's visits by the newly insured can be accommodated through organizational changes and changes in practice patterns...

It is critical that the expansion of health insurance coverage leads to improved access to care for those who were previously uninsured and does not limit access for those who already have coverage. Our results suggest that the current supply of primary care physicians and physicians in most specialties is sufficient to ensure this result will hold."




The Physicians Foundation stated the following in its Sep. 2014 "2014 Survey of America's Physicians Practice Patterns & Perspectives," available at its website:

"While for much of the last 30 years interest in primary care among medical school graduates has steadily declined, that trend has recently abated. Medical school graduates matching to family medicine residencies grew for the fifth consecutive year in 2014, and family medicine achieved a 96% residency fill rate... In 2013, primary care residencies gained 1,502 more residency positions than in 2012 with a total of 11,762 applicants matched to primary care residencies...

The ACA included only modest provisions to increase physician supply... but did provide for redistribution of unused Medicare-funded residency slots to facilities that agree to train more primary care physicians, potentially increasing the number of primary care doctors entering the workforce by several hundred per year.

The ACA also raised Medicare reimbursement for many primary care physicians who have seen their incomes rise in recent years... Emerging delivery models promoted by the ACA, including the patient centered medical home, will allow primary care physicians to further boost their incomes by coordinating care, [and] implementing preventive care...

[I]ncreased medical graduate interest in primary care does indicate where the healthcare system is headed and underscores the relative rise in importance and influence of primary care doctors, who are the targets of aggressive recruiting across the country and are in greater demand than any other type of physicians."




The Institute of Medicine (IOM) stated the following in its 2014 report "Graduate Medical Education That Meets the Nation's Health Needs," available at nap.edu:

"Although the committee was not charged with projecting the future demand for physicians, it reviewed recent projections and analyses of the capacity of the physician workforce to meet the nation's health needs. Some projections suggest imminent physician shortages that could prevent many people from getting needed health services. These analyses raise concerns that the rapid aging of the population and the expansion in health coverage resulting from the Patient Protection and Affordable Care Act will fuel demand for physician services far beyond the current capacity. However, the underlying methodologies and assumptions about the future in these studies are problematic. They generally assume historical provider–patient ratios using existing technological supports and thus have limited relevance to future health care delivery systems or to the need for a more coordinated, affordable, and patient-centered health care system...

Physician workforce analyses that consider the potential impact of changes and improvements in health care delivery draw different conclusions. These studies suggest that an expanded primary care role for physician assistants and advanced practice registered nurses, redesign of care delivery, and the use of other innovations, such as telehealth and electronic communication, may ultimately lessen the demand for physicians despite the added pressures of the aging population and coverage expansions."