Health Overhaul Likely To Strain Doctor Shortage

By: Lauran Neergaard - AP Writer
By: Lauran Neergaard - AP Writer

WASHINGTON (AP) - Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with
steps to improve the quality of care for the average person and
help keep us well instead of today's seek-care-after-you're-sick
culture. To benefit, you'll need a regular health provider.

Yet recently published reports predict a shortfall of roughly
40,000 primary care doctors over the next decade, a field losing
out to the better pay, better hours and higher profile of many
other specialties. Provisions in the new law aim to start reversing
that tide, from bonus payments for certain physicians to expanded
community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may
do more to help with the influx. Instead of the traditional
10-minutes-with-the-doc-style office, a "medical home" would
enhance access with a doctor-led team of nurses, physician
assistants and disease educators working together; these teams
could see more people while giving extra attention to those who
need it most.

"A lot of things can be done in the team fashion where you
don't need the patient to see the physician every three months,"
says Dr. Sam Jones of Fairfax Family Practice Centers, a large
Virginia group of 10 primary care offices outside the nation's
capital that is morphing into this medical home model.

"We think it's the right thing to do. We were going to do this
regardless of what happens with health care reform," adds Jones.
His office, in affiliation with Virginia Commonwealth University,
also provides hands-on residency training to beginning doctors in
this kind of care.

Only 30 percent of U.S. doctors practice primary care. The
government says 65 million people live in areas designated as
having a shortage of primary care physicians, places already in
need of more than 16,600 additional providers to fill the gaps.
Among other steps, the new law provides a 10 percent bonus from
Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people
insurance naturally drives demand. The Massachusetts Medical
Society last fall reported just over half of internists and 40
percent of family and general practitioners weren't accepting new
patients, an increase in recent years as the state implemented
nearly universal coverage.

Nationally, the big surge for primary care won't start until
2014, when the bulk of the 32 million uninsured starts coming

Sooner will come some catch-up demand, as group health plans and
Medicare end co-payments for important preventive care measures
such as colon cancer screenings or cholesterol checks. Even the
insured increasingly put off such steps as the economy worsened,
meaning doctors may see a blip in diagnoses as those people return,
says Dr. Lori Heim, president of the American Academy of Family

That's one of the first steps in the new law's emphasis on
wellness care over sickness care, with policies that encourage
trying programs like the "patient-centered medical home" that
Jones' practice is putting in place in suburban Virginia.

It's not easy to switch from the reactive - "George, it's your
first visit to check your diabetes in two years!" - to the
proactive approach of getting George in on time.

First Jones' practice adopted an electronic medical record, to
keep patients' information up to date and help them coordinate
necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who
needs what testing or follow-up and make sure patients get it on

Rolling out next is a custom Web-based service named My
Preventive Care that lets the practice's patients link to their
electronic medical record, answer some lifestyle and risk
questions, and receive an individually tailored list of wellness
steps to consider.

Say Don's cholesterol test, scheduled after his yearly checkup,
came back borderline high. That new lab result will show up, with
discussion of diet, exercise and medication options to lower it in
light of his other risk factors. He might try some on his own, or
call up the doctor - who also gets an electronic copy - for a more
in-depth discussion.

"It prevents things from falling through the cracks," says Dr.
Alex Krist, a Fairfax Family Practice physician and VCU associate
professor who designed and tested the computer program with a $1.2
million federal grant. In a small study of test-users, preventive
services such as cancer screenings and cholesterol checks increased
between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of
Family Physicians and Medicare, are under way around the country.
Initial results suggest they can improve quality, but it's not
clear if they save money.

Primary care can't do it alone. Broader changes are needed to
decrease the financial incentives that spur too much
specialist-driven care, says Dr. David Goodman of the Dartmouth
Institute for Health Policy and Clinical Practice.

"What we need is not just a medical home, but a medical

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