Concierge Medicine Today

Primary Care Shortage A Challenge to ACA

By John W. Mitchell, SPPR, CMT Contributor

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MARCH 10, 2014 – An important factor in the success or failure of the Affordable Care Act (ACA) will hinge on one of the most fundamental of economic laws: supply and demand. All the new patients gaining access to the health care system via insurance exchanges will need a doctor. To meet this surge, the health care system must rely on primary care doctors composed mostly of family practice and internal medicine physicians. However, this is shaping up to be a challenge. Two emerging trends — physician employment by hospitals and concierge medicine, where patients pay their primary care doctor a monthly fee for ready access, are emerging as potential disruptors to the population management principle of the ACA.  Population management seeks to actively manage wellness to prevent chronic illness leading to hospitalization.  To achieve this end, the US health care system will need primary care doctors to see more patients. And therein lies a potential problem.

The Annals of Family Medicine projects a shortage of 52,000 primary care physicians in the next decade; other studies have arrived at similar conclusions. The reason for such a shortage is evident when the demographics and finances of primary care medicine are considered. Primary care doctors are the lowest paid specialists in medicine owing to the fact they do few high reimbursing procedures, as do for example, surgeons, cardiologists and radiologists. Physician earnings in general have been decreasing for the past decade primarily from downward pricing pressure from insurance payers, both commercial and public payers.

Burnout rising among doctors?
For some primary care doctors in a traditional private practice, the only response to falling income is to work more hours to see more patients. This can necessitate seeing 35 or more patients a day and working 80-100 hours a week. It is no surprise that reports of physician burnout is prevalent. In a recent study conducted by the Mayo Clinic and published in the Journal of American Medical Association, Internal Medicine almost half of physicians are experiencing at least one symptom of emotional burnout, ranging from exhaustion to depersonalization to low sense of personnel accomplishment. The study, which Mayo believes is the first of its kind, states that doctors on the “front line of care” (primary care) are especially susceptible.



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