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.

a doctor tends to a patient in the US health care system
National Journal
Clara Ritger
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Clara Ritger
Jan. 24, 2014, 12:05 a.m.

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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