The Shortage of Physicians Who’ll Accept Patients with Government Plans [Updates, Foreword by Larry Johnson]

UPDATE: Do not miss today’s “A Nebraska doctor’s message for Ben Nelson.” Your blood will boil. (H/t to our reader sybilll for spotting this letter.)

Editor’s Note: Bumped up from October 21, 2009 because the latest version of the Senate’s Obamacare bill, reports the Christian Science Monitor, drops “provisions to increase payment rates to physicians treating Medicare patients.” This refusal to properly compensate doctors portends greater physician shortages, especially those willing to treat patients on state and federal aid programs, or those medical students interested in selecting family medicine as a career path.

Original October 21st post: Fox News — especially commentator and columnist Charles Krauthammer — and a few other media outlets have pointed out that doctors cannot make ends meet if their patients are primarily on Medicare or Medicaid. A public health plan will add to the numbers of patients that physicians will not be eager to serve. From RealPolitics‘ “Some Inconvenient Truths About Medicare and the New ‘Public Plan’“:

The looming doctor shortage could become a national crisis as prospective physicians, whose education requires many to incur massive debt, would reluctantly opt for occupations where the government does not control their livelihoods.

My community faced the loss of its major health care clinic a few years ago, and its patients fought like crazy to get the county hospital to save the clinic. To make my case in a letter to the editor, I called every single general and family practitioner in a 50-mile radius, and asked each office if they were taking (1) new patients, (2) Medicare patients, or (3) Medicaid patients.

Guess what I found out:

Not ONE physician’s office — not one — was willing to take ANY Medicare or Medicaid patients. And very few had any openings for new patients with good health insurance.

I summed up my findings in my LTE, which was the top LTE in the Sunday newspaper. I wasn’t as pleased with the featured letter as I was terrified about the prospect of hundreds and hundreds of local citizens no longer being able to find a doctor.

Many local physicians have retired early because they can no longer make a decent living because Medicare and Medicaid do not reimburse them sufficiently to warrant their keeping their practices open.

Luckily for my area, the county hospital came through, but at enormous expense. The first action the hospital took was to spend millions to upgrade the clinic offices to comply with Medicare rules for hospital-grade clinics that enable the clinics to seek higher reimbursements from Medicare. (I am not sure how Obama’s plan will affect the set-up that the hospital achieved, and pray that there’s no “fine print” in the bill that will reduce the Medicare reimbursements for which the hospital paid a lot of money in order to receive.)

I do know that, as reported on Fox News yesterday, Harry Reid et al. hope to add a plan to reimburse doctors more, but instead of finding money within the scope of the plan, Reid says he’ll simply add the expense to the national debt. Smart, Harry. Smart.

From “Prognosis: Doctor shortage in the region” published at nwi.com (a Northwest Indiana media company), here’s a more detailed look at the doctor shortage issue and the very practical issue of how people are going to struggle to find a physician under Obamacare:

Dr. Alex Stemer, president and CEO of Medical Specialist Centers of Northwest Indiana, said doctors are getting paid less now than in the past because of low Medicare and Medicaid reimbursement rates that do not cover the cost of providing care. Stemer said this lower pay makes it harder for new doctors to pay off loans.

“You enter practice as a doctor with typically a quarter of million (dollars) in debt,” Stemer said. The Association of American Medical Colleges estimates most students left medical school last year with more than $150,000 in debt, an increase of 11 percent from the previous year.
With health care reform a possibility in Congress, the question for many health care providers is how many more physicians will be needed to care for the U.S. population.

“The fact is that if you do increase coverage, there is eventually going to be an increase in demand,” said Dr. Pat Bankston, director of Indiana University School of Medicine-Northwest. “Without an increase in health care providers, then you’re guaranteed to slow down care. This is the whole idea of waiting in line and rationing, because you don’t have the providers to take care of you.”

Stemer agreed, adding the current federal health care reform legislation increases access for Americans without increasing capacity.

“The president wants everyone to have an insurance card and make an appointment,” Stemer said. “The president is thinking they’ll go to the office instead of the emergency room when they need care. So now what is going to happen when the (doctors’) schedules fill up?”

Dvorscak and Van Roo said they know what they will face.

“I think in the past (medicine) was a well respected profession, and I hope it stays that way, because we’re really privileged to be able to do what we do,” Van Roo said. “I think it’s a hard job, but it’s a really good job.”

I hope their idealism holds true. But I’ve talked to enough doctors to know that most are bone-weary from having to deal with government health plans that don’t fairly compensate them for their services.

The subtitle of “Prognosis: Doctor shortage in the region“?

SIDE EFFECTS: LONG WAITS, CLINICS OVER CAPACITY, DOCTORS STRETCHED TOO THIN, CARE RATIONING, MORE PRESSURE ON NURSES