Adding 30 million people to the health care system means longer waits, de facto rationing, and people still in the emergency room.
We have all heard that there is a shortage of physicians. Google it if you don’t believe me. One of the country’s leading physician recruiting firms has extensively studied this problem and has attempted to sound the warning with books ominously titled “Will the Last Physician in America Please Turn Off the Lights?”
Estimates range from short term physician shortages in the tens of thousands to shortages in the hundreds of thousands by the middle of the next decade. The reasons are many and complex. For one thing, a large number of physicians are approaching or area at retirement age. The number of residency slots has remained relatively stable since the late ‘90s, partially due to dependence on Medicare funding. With training ranging from six to 10 years after college, quickly producing more physicians is not an option. Now enter the Affordable Care Act, aka Obamacare, with greatly expanded access to routine health care. You don’t have to be a genius to see that the math doesn’t work.
Now I believe that everyone in this nation of ours deserves health care. Actually, I believe everyone in the US has health care but a lot of it is being delivered by emergency departments. Clearly, adding 30+ million people wanting to see the doctor means longer waits, de facto rationing, and people still in the emergency room.
Wait! If we can get everyone preventive care, teach them not to smoke, encourage them to exercise and lose that extra hundred pounds while not actually requiring them to do or pay anything, then we will all be healthy, the population will patiently wait until they can see their appointed primary care provider, and the cost of health care for the entire nation will go down and the overutilization of emergency rooms will be a thing of the past. I actually heard a state official make that statement or something pretty close to it. Yeah, right.
So who is going to take care of us? Obviously, English-as-a-first-language doctors will be less common. At some point the rest of the world may decide that they don’t want us draining their brains so that is probably not the ultimate answer. Nurses are already assuming a much greater role in health care delivery. Nurse practitioners are already very commonplace in our community and independently practicing nurses seem inevitable. Of course, then there is the nursing shortage. Other physician extenders will follow. Can it be long before your neighborhood pharmacist is prescribing more than flu shots?
In the radiology departments I work in we have critical value lists posted at each reading station because I can’t be trusted to know when I should call a physician about a life threatening finding. Recently, I read a first trimester obstetrical ultrasound that demonstrated a fetal demise. Per protocol, I picked up the phone and called the ordering physician who was actually a nurse practitioner and was told by the nurse’s nurse that the nurse had the afternoon off. I think the future is here.
Douglas G. Burnette Jr., MD, CFP®, has been a practicing radiologist for more than 30 years. He also started a second career in wealth management and continues to practice radiology part time as an independent contractor.