Insurance

JOHN GOODMAN: ‘Are We About To Face A Severe Doctor Shortage?’

Published on Friday, 13 December 2013 05:40      Written by John Goodman

concierge medicine popular“No, there won’t be a doctor shortage,” wrote Zeke Emanuel and Scott Gottlieb in The New York Times the other day.

ObamaCare will weather that challenge just fine. How? Nurses and other paramedic personnel can substitute for physicians and new technology is making remote monitoring of patients easier than ever before.

All that is true. But those changes are likely to happen slowly; and even if they happened quickly, I’m afraid that it won’t be enough.

Here’s why. Two features of ObamaCare will substantially increase the demand, while (surprisingly) nothing in the law increases supply. And when people take steps to increase their access in response to growing waiting times, the success of some will increase the rationing problems for everyone else.

At this point we have no idea how many people will become newly insured under ObamaCare. For the first year out, the number of people with insurance may actually go down! But the administration’s goal is to insure an additional 30 million people and eventually a lot of those people will acquire health plans. When they do, the economic studies predict that they will try to double their use of the health care system.

RELATED STORY | DECEMBER 2013
“Demand For Concierge Medical Care Currently Outweighs Supply of Physicians Across U.S.”

Adding to this increased demand will be new mandated benefits. The administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Then there are new benefits for women, including free contraceptives. And all of us will be entitled to a long list of preventive services — with no deductible or copayment.

But the health care system can’t possibly deliver on all these promises. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be increased rationing by waiting.

Take preventive care. The health reform law says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health, scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary care physician’s time each year, or 7.4 hours per working day.

And all of this time is time spent searching for problems and talking about the search. If the screenings turn up a real problem, there will have to be more testing and more counseling. Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.

When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.

How long does it take you on the phone to make an appointment to see a doctor? How many days do you have to wait before she can see you? How long does it take to get to the doctor’s office? Once there, how long do you have to wait before being seen? These are all non-price barriers to care, and there is substantial evidence that they are more important in deterring care than the fee the doctor charges, even for low-income patients.

For example, the average wait to see a new family doctor in this country is just under three weeks. But in Boston, with ObamaCare-type reform, the wait is about two months.

When people cannot find a primary care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms. Yet one study found up to 20% of the patients who enter an emergency room leave without ever seeing a doctor, because they get tired of waiting. Be prepared for that situation to get worse.

When demand exceeds supply, doctors have a great deal of flexibility about who they see and when they see them. Not surprisingly, they tend to see those patients first who pay the highest fees. A New York Times survey of dermatologists in 2008, for example, found an extensive two-tiered system. For patients in need of services covered by Medicare, the typical wait to see a doctor was two or three weeks, and the appointments were made by answering machine.

However, for Botox and other treatments not covered by Medicare (and for which patients pay the market price out of pocket), appointments to see those same doctors were often available on the same day, and they were made by live receptionists.

As physicians increasingly have to allocate their time, patients in plans that pay below-market prices will likely wait longest. Those patients will be the elderly and the disabled on Medicare, low-income families on Medicaid, and (if the Massachusetts model is followed) people with subsidized insurance acquired in ObamaCare’s newly created health insurance exchanges.

Their wait will only become longer as more and more Americans turn to concierge medicine for their care. Although the model differs from region to region and doctor to doctor, concierge medicine basically means that patients pay doctors to be their agents, rather than the agents of third-party payers such as insurance companies or government bureaucracies.

For a fee of roughly $1,500 to $2,000, for example, a Medicare patient can form a new relationship with a doctor. This usually includes same day or next-day appointments. It also usually means that patients can talk with their physicians by telephone and email. The physician helps the patient obtain tests, make appointments with specialists and in other ways negotiate an increasingly bureaucratic health care system.

Here is the problem. A typical primary care physician has about 2,500 patients (according to a 2009 study by the Centers for Disease Control and Prevention), but when he opens a concierge practice, he’ll typically take about 500 patients with him (according to MDVIP, the largest organization of concierge doctors). That’s about all he can handle, given the extra time and attention those patients are going to expect. But the 2,000 patients left behind now must find another physician. So in general, as concierge care grows, the strain on the rest of the system will become greater.

I predict that in the next several years concierge medicine will grow rapidly, and every senior who can afford one will have a concierge doctor. A lot of non-seniors will as well. We will quickly evolve into a two-tiered health care system, with those who can afford it getting more care and better care.

In the meantime, the most vulnerable populations may have less access to care than they had before ObamaCare became law.

John GoodmanJohn C. Goodman is President of the National Center for Policy Analysis, Research Fellow at the Independent Institute, and author of the book Priceless: Curing the Healthcare Crisis.

The Wall Street Journal and the National Journal, among other media, have called him the “Father of Health Savings Accounts.” Dr. Goodman’s health policy blog is the premier right-of-center health care blog on the Internet.

It is the only place where pro-free enterprise, private sector solutions to health care problems are routinely examined and debated by top health policy experts across the ideological spectrum.

Source: http://www.rightsidenews.com/2013121233593/life-and-science/health-and-education/are-we-about-to-face-a-severe-doctor-shortage.html

1 reply »

  1. Here’s the current downside in concierge medicine: We’ve (Concierge Medicine Today and our research arm, The Concierge Medicine Research Collective) have been studying the demand for concierge, direct care, cash only and retainer-based medical models by consumers for many years. We’re finding that the number of patients who are seeking concierge medical care is far greater than the actual number of primary care and family practice doctors available to serve them.

    “Despite what we hear in the media about the increase in concierge and private-pay physicians growing across America, there are simply not enough of these [concierge-style, direct care or membership medicine-style] physicians in the U.S. to meet the current demand,” said Michael Tetreault, Editor-In-Chief of Concierge Medicine Today and Executive Director of The Concierge Medicine Research Collective. “Interest in our LOCATE A DOCTOR search engine [for concierge-style, direct care doctors] has increased tremendously since the election and the first of the year. But, unfortunately, even if you include all of the doctors touting themselves as retainer-based or concierge medical practices — at the end of the day, the marketplace is still falling short.”

    There are currently four states that have a huge lead in the amount of active concierge or private-pay physicians in practice and consumers seeking their care. Florida, California, Pennsylvania and Virginia each have a significant number of people [most over age 50] seeking out concierge doctors and there is, fortunately, a sizeable number of concierge physicians to serve them.

    It’s extremely difficult to find a physician for those seeking concierge physician services in very rural areas like Idaho, North and South Dakota, Louisiana, Mississippi and others. Often times, we have found that there are less than half-a-dozen practitioners to serve an entire state says one Patient Connection Specialist at CMT.

    Top 10 Fastest Growing Cities For Concierge Medicine
    Source: Concierge Medicine Today and The Concierge Medicine Research Collective © 2013

    1) Los Angeles, CA

    2) San Fransisco, CA

    3) New York, NY

    4) Palm Beach, FL

    5) Baltimore, MD

    6) Washington, DC

    7) Philadelphia, PA

    8) Seattle, WA

    9) Chicago, IL

    10) San Diego, CA

    Merritt Hawkins released similar data from their survey among physicians considering opening a concierge medical practice stating the following:
    States with Doctors Considering Starting A Concierge-Style Medical Practice

    Texas: 10.6 percent
    Florida: 9.1 percent
    New York: 8 percent
    California: 6.7 percent
    North Carolina: 5.6 percent
    Illinois: 5.3 percent
    Washington State: 4.8 percent
    Pennsylvania: 4.5 percent

    “While the number of physicians entering concierge medical practices needs to increase,” adds Tetreault, “more transparent pricing among doctors is also needed. Unfortunately, our nation’s new health care reform law does little in this respect.”

    Increasing the Number of Concierge Physicians Across The U.S.

    There are three ways you can instantly increase the number of physicians stated above.

    First, understand that the terminology being used in the concierge medicine or direct care marketplace describes many types of business models where doctors have some form of non-insurance or direct financial relationship with their patients. While all concierge medicine practices share similarities, they may vary widely in their structure, payment requirements, and form of operation. But at the end of the day, price transparency, access, affordable rates and the personal level of service provided to each patient is what they all have in common.

    Second, understand that the term concierge medicine describes more specialties than just primary care, internal medicine and family medicine. Some dermatology, pediatric, cardiology and even dental practitioners are now providing a level of concierge medical care.

    Third, education. Most people understand that concierge medicine has had somewhat of a “brand/identity” issue. It’s been referred to as: membership medicine; boutique medicine; retainer-based medicine; concierge health care; cash only practice; direct care; direct primary care, personalized healthcare, direct practice medicine and, most recently, contract carrying healthcare. Because at its inception, it appeared costly, elitist and controversial, many people associated a “rich man’s” stigma to it. However, the consumer, the physician community and even some legislators are realizing that this form of healthcare delivery, when free-market driven, is saving money and providing “better care,” according to MDVIP hospitalization studies conducted in the past two years (See:www.ConciergeMedicineToday.com/hosp.html).

    WHEN PATIENTS of CONCIERGE MEDICAL CARE WERE ASKED TO WEIGH-IN ON WHY THEY CHOOSE CONCIERGE MEDICAL CARE, THEY SAID…
    Source: Concierge Medicine Today and The Concierge Medicine Research Collective © 2012

    • 34% said price was the main reason they chose concierge medical care

    • 17% said Medicare acceptance/participation was the main reason they chose concierge medical care

    • 6% said more time with my doctor was the main reason they chose concierge medical care

    • 29% said insurance compatibility was the main reason they chose concierge medical care

    • 6% said less office staff to deal with was the main reason they chose concierge medical care

    • 2% said limited/no waiting was the main reason they chose concierge medical care

    The takeaway here is that while price is important, it’s the additional selling features that help build your brand and make you more attractive to patients. The second takeaway here and important to note is that a lot of concierge practices focus on limited or no waiting at their office. While this is a nice feature of the practice, it was the least important aspect as to why patients choose concierge care for them and their family.

    “The recent Merritt Hawkins Study released this month [January 2013] tells us that growth in the physician marketplace for doctors expecting to transition into concierge or private-pay medicine is at less than seven percent,” continues Tetreault. “While this will keep some consultants busy for the next couple of years, the marketplace consumer is a long way from seeing a concierge doctor in every neighborhood.”

    Regardless of how you describe it or the term you associate with concierge medicine, the public’s perception of these healthcare delivery models is changing for the better. Patient retention among concierge medical physicians is 7 to 9 years, two years longer than traditional, insurance based primary care practices. We expect this number to increase as time passes and more data becomes available. When a physician is free to create pricing structures that meet their local demographic demands without the intrusion from insurance and avoid providing “hamster healthcare,” which only allows doctors to spend 6 to 9 minutes with their patients, you make a happier patient, healthier family and less frustrated and fatigued doctor who is able to care for their patients more thoroughly and comprehensively.

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