California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Health Reform Law Could Worsen Doctor Shortage, Experts Say

Although the Affordable Care Act is expected to extend insurance coverage to an additional 30 million U.S. residents in 2014, experts say a physician shortage could prevent many newly insured individuals from accessing services, the New York Times reports.

Projected Physician Shortage

The Association of American Medical Colleges projects a shortage of about 62,900 physicians in 2015, and expects that number to more than double by 2025. AAMC estimates that even without the overhaul, the shortage would top 100,000 by 2025.

Along with the health reform law's Medicaid expansion and population growth, the increase in baby boomers becoming eligible for Medicare is contributing to the shortage. Medicare officials expect enrollment to reach 73.2 million in 2025, a 44% increase over current enrollment.

According to the Times, individuals typically still are able to obtain care during a physician shortage, but doing so often is "slow and difficult."

Dustin Corcoran, CEO of the California Medical Association, said that physician shortages cause many U.S. residents to "access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker."

Little the Government Can Do

Many experts say there is little that the government or medical community can do to close the gap before 2014, when the ACA fully takes effect, according to the Times. The Times notes that it takes about 10 years to train a physician.

Medical school enrollment has increased, but it has not kept pace with the population. In addition, fewer medical students are choosing to become primary care physicians, as the salary disparity between primary care and specialists grows.

Provisions in the ACA are intended to address the physician shortage, such as increasing Medicaid primary care payment rates in 2013 and 2014 and launching new training programs. The law is expected to increase the number of primary care physicians by about 3,000 over 10 years. However, communities nationwide need about 45,000 more primary care physicians, according to the Times.

Mark Smith, president and CEO of the California HealthCare Foundation, said that the shortage will force the health care system to "use the resources that we have smarter." He added that building more walk-in clinics, allowing nurses to provide more services and encouraging physicians to work in teams all could help address the shortage (Lowrey/Pear, New York Times, 7/28). CHCF publishes California Healthline.

Number of Retail Health Clinics To Increase

As a result of the looming physician shortage, more walk-in clinics are expected to be established in the next few years, the Los Angeles Times reports.

CVS MinuteClinic -- which is the largest retail clinic chain nationwide, with 600 locations -- will open another 100 clinics annually. Target is scheduled to open nine more clinics this week, for a total of 53. Meanwhile, Walgreen has more than 350 clinics and Walmart has nearly 150.

Some experts say it is unclear whether the clinics will create more unnecessary care, or if the proliferation of facilities will undermine efforts in the ACA to boost care coordination, particularly for individuals with complex and costly conditions (Terhune, Los Angeles Times, 7/30).

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