More than 7 Million Enrolled, But Who Will Provide Their Care?

More Than 7 Million Sign Up for Health Coverage, the headlines boast.

However, just as millions of Americans are obtaining insurance coverage through the federal health law, many primary care doctors are retiring early, converting their practices to concierge or joining large healthcare and hospital groups. The primary care physician, also known as a “provider,” may be headed toward extinction.  They are tired of working longer and harder and frustrated by increasing oversight and the business of medicine — dealing with insurers, staff and office financials.

There are also new burdens in the practice of medicine. One such example is the electronic health record (EHR), an expensive to implement tool meant to improve communication among providers, improve health outcomes and make providers’ lives easier. An often heard complaint is that the physician spends the bulk of the patient visit documenting in the EHR rather than actually interacting with and caring for the patient.

Unhappy doctors make for unhappy patients, especially among those who serve on the front lines of primary care and play a critical role in coordinating patient care. The Association of American Medical Colleges estimates the United States will be short 45,000 primary-care doctors in 2020, compared to 9,000 today. 

There is clearly more to the equation of healthcare access than just having a method of payment.  There will need to be more robust efforts to attract and retain physicians in primary care, which also includes continued migration toward payments for outcomes rather than visits.  The "fee for service" and "per visit" payment system creates a financial incentive to deliver as many visits, exams, tests, and treatments as possible for financial sustainability rather than what is best for the patient. For most physicians, this is in direct conflict with the reason they chose a career in medicine.

Overhaul of the payment system will be a necessary part of transforming the US healthcare delivery system but seven million who now have insurance is a good start.


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