Is there a doctor in the house? Physician shortage likely to get worse

By Irwin Kellner, MarketWatch | PORT WASHINGTON, N.Y. (MarketWatch) — Is there a doctor in the house? Not much longer, the way things are going.

Already in short supply, the number of practicing physicians is declining — and the new health-care law will only make things worse.

The facts are that there are not enough doctors to treat today’s population, much less those becoming newly insured under the law.

Don’t take my word for it; when was the last time you were able to get an appointment to see one of your doctors as quickly as you wanted to? And how much time did you have to spend in the waiting room?

Yes, Virginia, this is a shortage of doctors, and it traces to a number of reasons.

First of all, even as the nation’s population continues to grow, fewer people are seeking to enter the medical profession these days.

According to the Association of American Medical Colleges, the number of medical-school students entering family medicine (where demand is the greatest) fell by more than a quarter between 2002 and 2007.

As a consequence, the AAMC says that nation could have a shortage of as many as 150,000 doctors in the next 15 years. With the number of U.S. doctors now around 954,000, this is a shortfall of more than 15%.

At the same time, many doctors are choosing to leave the profession. They are selling their practices and going to work for drug firms or to work as analysts or even as teachers.

Almost every doctor I speak with tells me that it won’t take much to push him or her into another field. Virtually no physician wants his or her children to become a doctor, since the costs involved far outweigh the benefits.

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The benefits are what drive people into medicine. These include caring for people, the esteem in which society places physicians, and the ability to earn a decent living.

Doctors still very much care for their patients and are still revered but at a growing cost. Most physicians are getting squeezed by private insurance companies, as well as by Medicare.

If they have a private practice, they have to deal with hospitals, and the need to embrace new technology (which can be costly) — not to mention the sequester, which just cut Medicare payments to them by 2% (on top of earlier reductions).

Then there are a growing number of forms that must be filled out, constant changes in regulations they must comply with, and a jump in medical malpractice insurance premiums to a level that many doctors can longer afford.

In addition, the new law mandates changes in the way doctors will be compensated. It goes from fee for service to fee for patient health. This will reduce doctors’ incomes even as it increases their liability.

To cope, some physicians are adopting the concierge model. They charge their patients an annual fee in return for providing care with less waiting time. Others are asking their patients to supplement what their insurance pays.

Those patients who can’t afford this will have to rely on their insurance. But a growing number of doctors have stopped taking insurance altogether – including Medicare.

This leaves the health-care system in a bind. Hospitals must care for anyone in need. They must take whatever insurance patients have, and treat the uninsured as well.

But to do this, hospitals need doctors who are becoming increasingly scarce. Can you blame them?

 Irwin Kellner is MarketWatch’s chief economist.

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