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It’s Hard to See Your Doctor. Is That Obamacare's Fault? It’s Hard to See Your Doctor. Is That Obamacare's Fault?

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Health Care

It’s Hard to See Your Doctor. Is That Obamacare's Fault?

Critics claim the health law will exacerbate the nation's physician shortage, but a closer look reveals a more complex issue.

On average, consumers wait 20 days to see a doctor.(AVAVA/Shutterstock.com)

photo of Clara Ritger
January 24, 2014

Republicans promise Obamacare will have you waiting weeks to see your doctor. One website says it can get you an appointment in 24 hours.

ZocDoc, a free online appointment-booking platform, allows patients to schedule last-minute doctor appointments by filling canceled or unbooked spots. The company launched in 2007, but it's betting its services will be in new demand as the Affordable Care Act takes effect.

The health care law aims to extend insurance coverage to 25 million new patients over the next decade, and that would—by design—create new demand for primary-care doctors. But those are already in short supply, and critics warn that the influx of new customers will exacerbate long wait times.

 

If it works, ZocDoc and other sites like it would ease the strain on the primary-care system, as every last-minute appointment means one fewer patient in the waiting line. But even at their best, such sites would address only a small piece of the central problem: The nation has too many patients and not enough doctors.

Experts are divided over whether that problem exists because of Obamacare, or in spite of it.

Julia Paradise, an associate director at the nonpartisan Kaiser Family Foundation, says other factors are mostly to blame.

"Population growth accounts for close to two-thirds of the doctor shortage, with aging 19 percent and expansion 15 percent," Paradise said, citing a study published in The Annals of Family Medicine. "The reality is that the strains in the system didn't begin with the Affordable Care Act. People with very good health insurance can't always get access to services when they need it."

Paradise says geographic maldistribution—the concentration of physicians in particular, often more-affluent urban and suburban areas—is a systemic problem that has always been a barrier to care for residents of poor or remote neighborhoods.

Obamacare is attempting to address the doctor shortage by sweetening the pot for medical students who go into primary care, a discipline less lucrative than many specialties. In the hopes of closing that gap, the law boosts payments for primary-care doctors for two years.

It's also incentivizing reforms to payment systems, encouraging doctors to provide better health outcomes the first time a patient walks in the door, and penalizing for readmissions at hospitals.

"Telemedicine can extend primary care in ways that wasn't available to us before," Paradise added.

But critics of the law are skeptical that those provisions can make up for the influx of new patients.

Grace-Marie Turner, president of the free-market-oriented Galen Institute, said the two years of higher pay for primary-care doctors isn't enough to get someone to go to medical school. And, she said, the regulations are creating a paperwork burden for doctors who are worried about getting penalized.

"We need to let doctors do what they do, which is take care of patients," Turner said. "But the third-party payment system has gotten so deeply ingrained in micromanaging doctors that they can't do their jobs. I worry about the waiting lines."

Other alternatives, such as allowing nurses to perform some tasks typically handled by doctors, have also come under fire.

"If you have a lot of people wind up practicing beyond their expertise, the patient is going to be harmed by that," Turner said. "Politicians are not the right people to be making decisions about health care. The industry is."

Consumers wait more than 20 days on average to see a doctor, according to a 2009 survey from Texas medical consulting firm Merritt Hawkins and Associates. That number is expected to rise given what happened in Boston after Massachusetts implemented its own health reform years before the Affordable Care Act was passed. The average wait time for a doctor's appointment, the survey found, is 50 days. While wait times will vary across the country, Massachusetts could be the crystal ball of the future.

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