In the late 1990s the feds decided that there was a doctor SURPLUS, and Medicare put a cap of 100,000 on residency spots Medicare would pay for as part of the Balance the Budget Act of 1997. This was a poor idea. Since then that time population has grown by 30 million and we have the rising needs of an aging population as well as the latest health care technology to offer them. Doctors are already overwhelmed with the patients we do have and don't have room for 30 million more.
What can be done? We certainly need more federally subsidized residency spots and more federal subsidies for tuition and loan forgiveness especially for primary care. But where is this money going to come from? Congress has already broken the bank by extending health insurance to 32 million more people. I believe strongly that reimbursements should be increased to doctors across the board rather than decreased. We need the permanent doctors' fix, not just getting rid of this year's looming 21 percent Medicare cuts. We need substantial tort reform to encourage surgeons and specialists to continue to practice despite rising expenses and declines in reimbursement.
There is already a growing doctor shortage in the U.S. with a projected 160,000 shortage by 2025 according to the Association of American Medical Colleges. In addition, less of our best and brightest will choose medicine because of increasing tuition but decreasing reimbursements. Few are choosing primary care medicine because of declining income. Fewer specialists are accepting insurance which creates an effective shortage even among doctors who are still practicing.
The biggest shortage problem involves the distribution of doctors. There are gaping Health Professional Shortage areas, especially in the midwest, west, and south, where 65 million people don't have proper access to doctors or nurses. Just because you have health insurance doesn't mean you can get care. Referral networks are drying up as fewer doctors accept insurance.
Nurse practitioners are on the rise, but cannot simply replace doctors. For one thing they don't have the same training and are not equipt to handle all the new technologies, for another, laws vary from state to state in terms of what they are allowed to do. In some states they can prescribe medications, in other states they can't. The provider-patient relationship is a one on one event. It is difficult to supervise. It is also difficult to simply replace the doctor you are used to with a nurse practitioner who doesn't know you.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of a new ebook: Swine Flu; the New Pandemic. Dr. Siegel is also the author of "False Alarm: The Truth About the Epidemic of Fear"and "Bird Flu: Everything You Need to Know About the Next Pandemic."Read more at www.doctorsiegel.com
Marc Siegel MD is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a medical analyst and reporter for Fox News since 2008. His upcoming book concerns a mysterious viral outbreak.