Access to primary care
Between now and Election Day, I will be inviting your comments about the big health care issues that neither Senator McCain nor Senator Obama are addressing--or at least not emphasizing in the campaign.
Today's topic: the impending collapse of primary care medicine in the United States.
In January 2006, the American College of Physicians warned that primary care was heading for collapse, citing the decline in the numbers of young physicians choosing primary care specialties like general internal medicine, and evidence that general internists were leaving the field in greater numbers than subspecialists. The paper received a lot of favorable comment, but also a fair amount of comment that the word collapse overstates the problem.
Now, few argue the point that the United States is facing a huge shortage of primary care physicians for adults. A study published in Health Affairs estimates a shortage of 35,000 to 44,000 primary care doctors for adults by 2025. The Journal of the American Medical Association reports that only two percent of fourth year medical students plan to go into general IM. The message is getting out to the broader public as well: the November Reader's Digest writes that "soaring office costs demanding insurance companies, low Medicare payments, staggering debt, and politicians who refuse to make hard choices are driving primary care physicians out of business." ACP President-elect Joe Stubbs, a general internist in Albany, Georgia, was quoted by Reader's Digest as calling the primary care issue "an evolving crisis of unprecedented proportion."
Yesterday's Washington Post reported that the experiences in the two states have guided the health care reform proposals of Senators McCain and Obama: Senator Obama has looked to the Massachusetts experience, and Senator McCain has looked to Minnesota. As the Post noted in its article, "the large number of people who have gotten insurance [under the Massachusetts plan] and are suddenly looking for care has aggravated a shortage of family physicians and other primary-care doctors" in the Commonwealth.
So what have the candidates said about primary care? Not too much. As ACP's comparison of the candidate's positions shows, Senator Obama's plan mentions the importance of primary care and the need to reduce medical education debt, but that is about it. Senator McCain's plan does not propose any policies to address the primary care shortage, although the GOP's convention platform mentions its belief "in the importance of primary care specialties and supporting the physician's role in the evaluation and management of disease."
The problem for the next President is in the absence of policies to reverse the collapse of primary care, access and outcomes will be poorer and costs higher. Even if the new President and Congress could agree on a plan to dramatically reduce the number of uninsured, they may find that there aren't enough primary care doctors left to take care of them, just as Massachusetts has found. Giving someone an insurance card doesn't give them access if they can't find a primary care doctor to take care of them.
Today's questions for our readers: Do you agree that primary care is nearing collapse? If so, what should the next President do about it?