As the Affordable Care Act is in full swing, there’s a lot of apprehension and perhaps, sometimes, enthusiasm about what is truly in store for the medical profession.

The last time you visited your doctor you may have noticed that he or she was more apprehensive,  cautious, and yes, maybe more overwhelmed.  The fact of the matter is that the health care profession is undergoing the most significant renovation to ever happened in the history of the United States.

Here are many things that keep many doctors awake at night:

1.  A new wave of new patients.
Now that insurance companies must accept people with pre-existing conditions, and dependents under the age of 26, there is a new floodgate that has opened, which will bring more people into the system to see a primary care physician.   In addition, many states will be expanding their Medicaid rosters, which will also introduce a greater volume of patients all competing for a limited number of physicians.

The projected shortage in primary care physicians between now and the year 2020 is expected to exceed 90,000 by some estimates, which means we have a real supply and demand issue.  Either physicians will have to extend their hours and see more patients, or patients will have to wait longer to get an appointment.

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2.  The paycheck could start shrinking.
Although one would think that a rise in patient volume would correlate into higher income, reimbursements for many specialties could, in fact, be reduced under ObamaCare.  There are proposed cuts of almost $718 billion out of Medicare, which will be based on reduced reimbursements and reduction in fraud and waste in the health care system.  There is no question that there is room for improvement in reducing the number of unnecessary or duplicate tests being done, but the real concern for doctors is a lot of these decisions will be made by IPAB, the Independent Payment Advisory Board, which will dictate the standards.

3.  The wonders of technology.
Every physician is now required to implement an electronic medical record as a means of standardizing information gathering and sharing in the health care industry.  This is a good idea.  The problem is that in order for a physician to effectively implement a new system, they need to cancel patients for a few months in order to accommodate the transition in learning, which in turn, creates a backlog.

There is, of course, the cost of implementing a new system that will eat into the profits a doctor already earns (and is potentially diminishing).  Doctors may even need to hire newly skilled staff to manage these systems and convert their manual records to an electronic one. Technology is important, but the road to success will be rocky.

4.  Decreased face time.
With a increasing volume of patients and increased demands on technology and reduced reimbursement, what might ultimately happen is that patients spend less time with their doctor -  less than even the average seven minutes.  The domino effect from here is that patients get less questions answered, and doctors are more exposed to missing things in the process.   In addition, there is the likelihood this could lead to more tests being ordered because there is simply no time to take a good history that is often the crux of an accurate diagnosis.

5.  Staying connected.
A major part of the new delivery system is accountable care organizations, which are designed to improve coordination between doctors, hospitals, patients and care takers.  Many doctors will soon be reimbursed through a bundled fee for the services that are delivered for an individual for all of the doctors responsible.  It will now be critical that doctors are able to understand what tests and evaluations were done before and after a patient’s visit in order to best be able to coordinate care.

Hospitals will be penalized if patients come back within a certain period of time, and it will be very important for them to be able to communicate with the primary care doctors to make sure the patient complies with their appointments, medications and any other care.

7.  The doctor-patient relationship.
As insurance companies try to get more market share, many of them are buying up doctors' practices and aligning themselves with hospitals to create a monopoly.  This is not very different from the days of managed care.  Most of us are used to physician choice, and there is nothing more special than the relationship with our doctor.  The trend remains that with future consolidation of the market, many doctors could be excluded from certain networks , and you may no longer be able to see the doctor of your choice.
The years 2013 and 2014 will be big years for the health care profession and the next time you visit your doctor, you might put these points into perspective, as this might ultimately impact the future of your care.