Obama Administration Looking To Increase Physician Supply Without Increasing Costs
The Obama administration is taking steps to address a nationwide shortage of physicians in order to meet the needs of an aging population and millions of uninsured people who would receive health insurance under legislation supported by the president, the New York Times reports. According to the Times, administration officials are especially concerned about a shortage of primary care physicians. At a previous White House forum on health care, President Obama said, "We're not producing enough primary care physicians," adding, "The costs of medical education are so high that people feel that they've got to specialize."
One proposal being considered to address the problem would increase Medicare payments to PCPs but reduce payments to specialists. The Medicare Payment Advisory Commission has recommended an up to 10% increase in reimbursements for many primary care services, including office visits, and recommended that Congress reduce payments for other services to offset the increase. Senate Finance Committee Chair Max Baucus (D-Mont.) said Medicare payments have been skewed against PCPs, who provide the majority of care for chronic conditions such as congestive heart failure, diabetes and Alzheimer's disease. Specialists are lobbying against such action, saying that Congress should increase reimbursement to PCPs without reducing payments to specialists.
Another proposal aimed at increasing the number of PCPs would increase enrollment in medical schools and residency programs, while another proposal would encourage increased use of nurse practitioners and physician assistants. The Association of American Medical Colleges has recommended a 30% increase in enrollment in medical schools, which would produce an additional 5,000 physicians annually. A separate proposal would expand the National Health Service Corps, which sends physicians and nurses to rural and low-income areas.
"Primary care physicians are grossly underpaid compared with many specialists," Baucus said. Baucus has said he would include increased primary care reimbursements in health reform legislation. Peter Mandell, a spokesperson for the American Association of Orthopedic Surgeons, said that the group has "no problem with financial incentives for primary care" but does have a "problem with doing it in a budget-neutral way." He added, "If there's less money for hip and knee replacements, fewer of them will be done for people who need them."
Atul Grover, chief lobbyist for AAMC, said, "If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older." Grover said that it is "completely reasonable to say that adding more physicians to the work force is likely to increase health spending," adding, "We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatment will be less necessary" (Pear, New York Times, 4/27).