Is the physician shortage real or imagined?
02/20/02 - Hal Prink

The first question to ask is "Why do we foresee a shortage of physicians?" The reasons are quite obvious. Physicians have lost control of their profession with the advent of managed care and onerous contracts, which leave little, if any, room for negotiation. Also, physicians saw an opportunity with acquisitions of their practices by hospitals or physician practice management companies that appeared to be a savior for their management and financial needs. Many of these failed and they have been left holding the bag.

In addition, patients are becoming more knowledgeable with information gathered from the Internet, advertised drugs, and their continued insatiable appetite for healthcare, therefore demanding more from their physicians.

As a result of these activities in the commercial marketplace, revenues did not keep pace with costs; staffing issues arose due to increased paperwork and management of contract requirements, and a general dissatisfaction with their profession.

National data indicates that 48% of the doctors when they reach age 50 will either retire or get jobs in a non-medical profession. This combined with the decline in medical school enrollments paints a pretty glum picture for our future of having sufficient physicians to care for our aging and expanding population.

HMO's are having difficulty maintaining adequate networks or primary care physicians, and in Texas it has gotten so bad that PacifiCare has been put on the State Insurance Commissioners list of plans having serious network adequacy problems.

Looking beyond the commercial market and into the Medicare program paints even a bleaker picture.

In the market the author of this article resides (Colorado) we are currently at 15% of the primary care doctors accepting new Medicare patients. In addition, Medicare HMOs' are experiencing network adequacy problems also.

Why are so few accepting new Medicare patients? The major reasons cited are as follows:

" Low level of reimbursement
" Paperwork requirements
" Fear of reprisal - fraud and abuse

All of these are valid reasons, which the federal government could take action to remedy it they want to retain the Medicare program. There are over 135,000 pages of regulations that cover the Medicare program. In having to deal with this program on a daily basis, even for one knowledgeable about the program it is difficult. Think of an 85-year-old widow trying to figure out the next step in dealing with this program as well as the other healthcare professionals that depend on it for reimbursement. Answer: It needs to be simplified.

Reimbursement levels should be analyzed and made more compatible with current day cost of practicing medicine.

Regulations on fraud and abuse are way too onerous and need to catch those who are deliberately trying to defraud the government, not those that inadvertently bill incorrectly. The government on the statement of benefits and the AARP encourages reporting fraud and abuse. They could better spend their time simplifying the regulations and explaining what is covered rather than trying to catch someone who is trying to provide quality healthcare to their members.

How do we solve the problem? Let doctors get back in control of the delivery of health care. It needs to be a cooperative venture between all providers to develop a healthcare system that will best address the needs of the consumer.
The consumer MUST change their insatiable appetite for healthcare. They need to realize that a government or commercial program cannot cover everything. They need to ask themselves the question: " Do you want the newest healthcare or the best healthcare". This especially holds true for drug costs. New does not always mean best but most likely it is the most expensive.

Much more could be said about prescription drugs, managed care companies but I wanted to focus for this article on the physician shortage. I have simply scratched the surface on this issue and would welcome comments from readers.

Hal Prink has over 35 years of healthcare experience including 22 years in healthcare association management with a focus on adult continuing education and healthcare research/survey activities. Most recent experience in the nonprofit sector was as a Medicare Patient Advocate assisting seniors on the complexities of the Medicare program.

back to senior reports