The Affordable Care Act — with all its newly insured — is predicted to further strain America’s already thinly stretched provider network.
Some predictions are more dire than others, and there’s little consensus on what do to about it.
In one camp is the Association of American Medical Colleges, which predicts that by 2020, if more doctors aren’t trained, the country will face a shortage of 90,000 primary-care and specialty physicians to care for an aging and growing population. Medical schools are on course to produce 7,000 additional graduates every year during the next decade, the association says. But more residencies are needed to train those graduates, which will require federal funding.
On the other side are policy experts who argue for making the financially bloated system more efficient through better preventive care, exploiting technology (virtual doctor visits and electronic medical records) and by delegating more of the workload to nurses and physician assistants.
Utah lawmakers this year are exploring a mix of solutions to tackle the doctor shortage.
Early debate has centered around whether the state’s only medical school, at the University of Utah, is producing enough primary-care doctors.
Providing better access to primary care tackles the problem on all fronts by preventing disease, thereby easing the burden on the health system, said Marc Babitz, a family doctor and director of family health and preparedness for the Utah Department of Health. Family docs also care for the whole patient, delivering better continuity of care, which reduces costly mistakes and duplicate tests and treatments, he added.
At a recent Social Services budget committee hearing, Babitz suggested that Utah lawmakers consider attaching strings to $10 million that funds slots at the medical school — not a quota, he said, just some sort of incentive.
The United States is the world’s only outlier in having more specialists than primary-care doctors, Babitz said. Here the ratio is 70 specialists to 30 family docs compared to an international average ratio of 40 specialists to 60 family physicians.
Utah isn’t immune to the shortage, which is especially severe in rural regions. The state has 54 primary-care doctors per 100,000 rural residents, compared with 72 per 100,000 residents in urban settings.
“There’s room for improvement,” said University Health Care CEO Vivian Lee.
But the U., she added, is already a top performer for its proportion of graduates who choose the primary-care fields of pediatrics, family and general internal medicine and obstetrics and gynecology.
Between 2003 and 2012, an average of 38 percent to 45 percent of the school’s graduates chose primary-care residencies. And many stay there, instead of moving on to specialize, she said. The most recent data available show 34 percent of the U.’s graduates from 1997 to 2001 stayed in primary care, landing the school among the nation’s top third, Lee said.
Before Lee took the helm, the U. started putting medical students through clinical rotations as early as their first year — and in primary care.
“Exposing them early is a way to show this is a very viable and rewarding profession,” she said.
Under Lee’s leadership, the U., with help from its alumni association, also started a scholarship pool that graduates can tap to repay their student loans once they’ve finished their residency and decide to pursue primary care. Specialties pay more, encouraging some debt-laden residents to shun primary care, Lee explained.
The U. is also one of four schools participating in a national experiment to shorten the training time for doctors — pediatricians, in this case. “If you can get more people through faster,” she said, “you can start addressing shortages sooner.”
The experiment involves identifying promising pediatric candidates in their first year of medical school and exposing them to pediatric rotations upfront. Even the specialties they encounter, from surgery to anesthesia, have a pediatric focus, Lee said.
Market forces are also bound to have an influence, she contends.
“As we move from fee-for-service and high-end speciality care to more constrained payment models that reward providers for keeping people healthy, I think we all see the role of primary-care providers growing,” she said. The U.’s hospitals and clinics this year increased their primary-care workforce by 30 percent.
“I do MRI and radiology, the most expensive thing,” said Lee, a radiologist. “But I tell students, ‘Honestly, if you’re looking for job security and financial stability, I’d do primary care.’ ”
Utah doc shortage
Among remedies being floated by Utah’s Legislature are several budget requests and bills:
Rep. Ronda Menlove, R-Garland, wants money to expand telehealth offerings, enabling specialists to consult remote primary-care providers in rural areas.
Rep. Tim Cosgrove, D-Murray, is seeking money to fund more charity clinics and to restart a defunct loan-repayment program for medical school graduates who agree to work in underserved areas.
SB168 would shield health providers who volunteer at federally qualified charity clinics and Indian health centers from being sued — except for gross, wanton or willful negligence. “Many physicians in this state would be willing to volunteer their services if they were not subject to the high exposure of liability,” said sponsoring Sen. Allen Christensen, R-North Ogden.
SB125 would allow retired health providers to get a “volunteer health practitioner license” from Utah’s Division of Occupational and Professional Licensing if they previously had an unrestricted license in any state, district or territory of the United States.