Universal Coverage Exacerbating ‘Imbalance’ Between Supply of Physicians, Number of Patients in Massachusetts

Massachusetts' health insurance law has had the "unintended consequence" of exacerbating the "imbalance" between supply and demand for primary care physicians, the New York Times reports. Since the law took effect last year, about 340,000 of the state's estimated 600,000 uninsured residents have obtained coverage. However, the number of physicians in the state has not increased, leaving many newly insured residents "searching for doctors and scheduling appointments for long-deferred care," and forcing physicians to take on additional patients and reduce time spent with patients, according to the Times. The Times reports that the "situation may worsen as large numbers of general practitioners retire over the next decade."

Patricia Sereno, state president of the American Academy of Family Physicians, said "It's a recipe for disaster," adding, "It's great that people have access to health care, but now we've got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care." Jon Kingsdale, executive director for the Massachusetts Health Insurance Connector Authority, said he had not heard of major problems but acknowledged "the prospect of a severe shortage" as patients shift from seeking care in emergency departments to physicians' offices.

National Trend
A "confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services" in some rural and urban areas across the U.S., the Times reports. According to the Times, "Whether there is a national shortage of primary care providers is a matter of considerable debate," as "[s]ome researchers contend the U.S. has too many doctors, driving overutilization of the system." However, "there is little dispute that the general practice of medicine is under strain at a time when there is bipartisan consensus that better prevention and chronic disease management would not only improve health but also help control costs," the Times reports. According to the American College of Physicians and AAFP, the aging population in the U.S. will require 40% more primary care physicians by 2020.

David Dale, president of the ACP and former dean of the University of Washington School of Medicine, said, "I think it's pretty serious," adding, "Maybe we're at the front of the wave, but there are several factors making it harder for the average American, particularly older Americans, to have a good personal physician." According to the Times, the number of medical school graduates in the U.S. entering family medicine training programs, or residencies, has declined by 50% since 1997. There have been slight increases in the number of physicians training in internal medicine, but the share of those residents who establish general practices has dropped to 24% in 2006 from 54% in 1998, according to the ACP.

Meanwhile, a Government Accountability Office report released in February found that the number of primary care physicians per capita increased by 12% from 1995 to 2005 -- more than double the rate for specialists. The report also showed that there are fewer U.S.-trained physicians pursuing primary care, and there has been rapid growth in the number of physician assistants and nurse practitioners. A. Bruce Steinwald, GAO director of health care, said there is not a nationwide physician shortage, but the U.S. must overhaul the fee-for-service reimbursement system, which he said undervalues primary care while rewarding expensive procedure-based medicine (Sack, New York Times, 4/5).