|The State of America's Health Care Is Poor|
February 2, 2009
"The state of America's health care is poor," Jeffrey P.
Harris, MD, FACP, president of the American College of
Physicians (ACP), reported today at the annual State of
the Nation's Health Care briefing.
"There are too many uninsured and underinsured people.
We have too few primary care physicians."
"The problems are big, so the solutions must also be
big," Dr. Harris declared. At the briefing, ACP provided
recommendations on how President Obama and Congress can
take immediate, sustained, and dramatic steps to provide
affordable and accessible health care to all Americans
and provide every American with access to a primary care physician.
The Institute of Medicine (IOM), a private,
non-governmental organization, recently announced that
the U.S. needs 16,000 more primary care physicians just
to meet the needs of currently underserved areas. The
shortage will grow to 40,000 or more physicians,
assuming current rates of health insurance coverage,
according to two recent studies. At a time when
America's aging population is increasing, the demand for
general internists and family physicians will continue
to grow at a much faster rate than primary care
physician supply, in the absence of policies to
immediately and substantially increase primary care
"Giving all Americans an insurance card will not
guarantee that everyone will have access to care," Dr.
Harris emphasized. "There are not enough primary care
physicians to care for them."
To underscore the importance of the timing, Dr. Harris
added: "Given the fact that it takes a minimum of seven
years to train a primary care physician (medical school
and residency combined), the U.S. cannot afford to delay
implementation of policies to attract more new
physicians to primary care and to sustain those already
Therefore, policies to expand primary care workforce
capacity need to be implemented immediately and go
hand-in-hand with coverage expansions. We need to act
now to influence the career choices of medical students
and physicians already in residency programs, and the
retirement and career decisions of primary care
physicians already in practice."
The ACP recommendations also call for: - Setting
specific goals for increasing primary care, including
policies to achieve them and measures to evaluate their
Reforming primary care payment policies to achieve
market competitiveness with other specialties,
including immediate and sustained increases in
Medicare fee-for-service payment;
Expanding the Patient-Centered Medical Home, and
Issuing an Executive Order by President Obama to
assure that all federal agencies are working together
to set primary care workforce goals and the policies
necessary to achieve them.
ACP's briefing cited several examples of how patients
will suffer if health care reform does not expand the
primary care physician workforce capacity at the same
time as coverage is expanded:
For the newly insured, there will be long wait times
to get an appointment with a primary care physician,
if they are able to find one at all.
In a growing number of communities, it may become
impossible for people who do not currently have a
relationship with a primary care physician to find an
internist, family physician or pediatrician who is
taking new patients. Not because established primary
care physicians do not want to accept the
newly-insured into their practices, but because they
have no time left in an already over-scheduled day to
take on any additional patients.
Patients will have less time with their primary care
doctor. Despite insurance coverage, without changes in
the way care is provided, physicians may have to
further decrease the time they currently spend with
patients in order to try to accommodate increased
demand for services associated with covering more
Americans -- which could have a negative impact on
quality, access, and timeliness.
Massachusetts' experience is a case in point of what
can happen if coverage is expanded without expanding
the primary care workforce. When health insurance
coverage was recently expanded to nearly 95 percent of
the state's residents, some low income residents
reported difficulty finding a physician or getting an
appointment. In fact, the wait to see primary care
physicians in Massachusetts has reportedly grown to as
long as 100 days.
ACP's recommendations are supported by the 126,000
member organization's new comprehensive evidence review,
How is a Shortage of Primary Care Physicians Affecting
the Quality and Cost of Medical Care? Using more than
100 studies, the paper notes that "even though decades
of research tell us that primary care is the best
medicine for better health care and lower costs, the
current U.S. health care system fails to support
policies and payment models to help primary care survive
A paper published by the ACP in the Annals of Internal
Medicine that compared U.S. health care with care in
other industrialized countries found that the best
performing health care systems abroad, unlike the United
States, are built on a strong foundation of primary care.
"A better health care system must result in everyone
having health insurance coverage, and everyone having
access to a primary care doctor. Anything less than that
will fail to provide Americans with access to
affordable, comprehensive and personal care they need
and deserve," Dr. Harris said in concluding ACP's State
of the Nation's Health Care briefing.