Considering the Provider Side of the Healthcare Equation

Considering the Provider Side of the Healthcare Equation



The Physicians Foundation has released a report chronicling the growing frustrations of primary care physicians in America. The report indicates that as many as half of the nation’s primary care Family Medicine and Internal Medicine doctors may consider quitting in the next three years.

Why? The answer is pretty simple: too much bureaucracy.

There is already a shortage of primary care physicians in the U.S. and the problem is likely to increase:

[M]ed school students are shying away from family medicine. In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That’s because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness.

The costs of running a practice are high and insurance payments for many routine procedures continue to decrease, thanks in a large part to the decreasing payouts from Medicare and Medicaid whose payment structure private insurance companies often emulate. In fact, Medicare and Medicaid are becoming such money losers for physicians that:

[O]ver a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients.

Here’s the part where I talk about national health care plans (you knew this was coming). One of the biggest challenges in designing a national insurance plan is figuring out how to spread limited resources over a larger population without significantly raising costs OR pushing providers to quit or move to a private pay system where they treat only those willing to pay cash (i.e.: the wealthy).

If we’re already short on primary care doctors and a third of those are already declining Medicaid, how on earth will we get enough providers to participate in the new system without significantly raising payouts to entice and retain primary care doctors? And if we raise payouts, that increases the overall costs associated with the healthcare system.

Or we could just cross our fingers and hope it all works out. Unfortunately, that seems unlikely given that the current healthcare market, in its heavily regulated non-free-market form, is already failing to create the incentives necessary for a strong base of primary care providers. Would placing more regulations and more layers of bureaucracy really improve the situation?

If President-elect Barack Obama wants to provide universal or near-universal healthcare, he and Congress must consider the effect their plan will have on providers. Generally, physicians are just as jerked around by the insurance system as are their patients. Their concerns should also be just as relevant. Any national healthcare system has to find a way to make primary care a reasonable and profitable option for physicians, or we’ll have a massive shortfall of providers. And that won’t benefit anyone.

  • Susanna

    In an editorial in today’s paper ( the writer mentioned that part of the problem is insurance pays doctors per procedure. If the pay structure were changed to better compensate doctors for regular checkups, it would benefit family physicians and encourage people to get those regular checkups so they stay healthier.

  • Jonathan Mazal, BSRT(R)(MR)

    I just finishged watching Dr. Gupta’s report on CNN of the doctor shortage crisis (specifically in primary care). Though I understand the physician’s concern with soon-to-be-President Obama’s promise of universal healthcare and a physican for all, I cannot help but get aggrevated at the lack of consideration on a very credible answer to this issue.

    The Physician Extender (Ex: Physician Assistants, Nurse Practioners, Nurse Anesthesist, Radiologist Assitant, etc). This career has been around since the 1960’s offering a time saver to MD’s, maintenance of quality patient care, as well as as being dramatically cost efficient. These health care workers are stae/nationally certified and ready to take on the ever growing population of patients under the observation of the physicians.

    Why is nobody talking about this potential remedy to physician shortages?

  • George Mauer

    No question, a complete overhaul of the system is needed. What I object to is the idea – nay, the mindless belief – that privatized insurance is more efficient because of the auto-magic of the free market. That is a complete misreading of a theory that does not even apply to the particulars of the situation to begin with.

    Once everyone can admit that throwing health insurance to the free market is not necessarily the best course of action we can start talking about possible solutions.

    PS The above did not address the article but at least it helps me blow off some steam from an argument I was having recently with a friend.

  • ChuckRN

    The babies don’t like their own system?!? They are the largest lobbyist group in the nation. Maybe if they worked in a job that required a little commitment to actual patient care they would understand. The bulk majority are not concerned with anything but themselves. They should decrease the number of physicians to those that understand mutual respect and caring. Otherwise, who needs these outdated elitist that are so out of touch with reality….. The abuse they hand out to health care staff is reprehensible. Nursing professionals have figured out that health care is paramount to success. Should the mechanic be the one with the most fanfare? No, it is the driver that guides the vehicle and ultimately provides for success. Physicians get too much credit for the work that nurses do. GET OVER YOURSELVES!

  • bubbles

    let’s just abolish healthcare. easy solution.

  • J. Harden

    Yeah, I’m with ChuckRN! DOCTORS SUCK! In fact, all smart people that do things…generally SUCK! Dumb and lazy people are the vast bulk of humanity and dumb and lazy people ROCK! If it weren’t for dumb and lazy people, smart do-things people wouldn’t have anything to do, nor would they really be that smart since there wouldn’t be anyone to compare them too…so there…smart do-things people — why don’t you just back off and stop trying to be so f-ing smart and to do things…let the dumb lazy people do stupid things if we can muster up the motivation to do them. Like ChuckRN says, “GET OVER YOURSELVES!”

  • I. Overberg

    I had heard that the universal health care was a bad idea really only for the patient. The patient would have to wait on any care needed, until the provider could give any care. To clear up want I’m saying; if a person needs a liver transplant in the next week and came later then someone who needs it in like 2 months, the person who came first would get the care needed. I read this now and i see that really its a two way street. Providers who need the money to keep open are having to close because of the falling payments form the insurance companies. With a universal health care system we really aren’t helping anyone, were just hurting ourselves. Pretty much what the article and I am saying is that, no providers means a lot of sick people. There are better ways to help the poor with there health, but this is not one of them.

  • Nick Benjamin

    You’re over-generalizing when you say that about a universal system. There are many, many, many different ways to run a universal health care system. Some cost more, some cost less. Some work great, some suck. They all cost less than our system, and their patient have better overall health. Heck the second crappiest health system in the developed world is Canada’s, it’s all funded through their government, which spends less on health care than our government.

    The only people who get screwed in every single kind of universal system are bureaucrats. In Michigan, for example, one of the best jobs available is “Medical Billing Specialist.” It turns out every insurance company has it’s own set of paperwork. This means a Doctor whose patients use 12 different companies has to know 12 different sets of forms, and billing codes, or not get paid.

    Now back to the original reason this thread was started. We don’t have enough family doctors. IMO the solution to this problem is simple. Free tuition for anybody in school to become a GP. That could actually be done at the state level — you’d just require anybody using that program to work as a GP in that state for 5 years.