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Doctor shortage expected to worsen with Obamacare

By   /   September 19, 2013  /   10 Comments

By Rob Nikolewski │ New Mexico Watchdog

HARD TO FIND: A state report says that New Mexico's doctor shortage will be get worse as aspects of the Affordable Care Act kick in.

HARD TO FIND: A state report says that New Mexico’s doctor shortage will be get worse as aspects of the Affordable Care Act kick in.

SANTA FE – For years, New Mexico has suffered from a chronic shortage of doctors, especially in the rural communities of the state.

Now, with the rollout of the Affordable Care Act, plus the decision by Gov. Susana Martinez to approve Medicaid expansion and creation of state health care exchanges, up to 172,000 uninsured New Mexicans are expected to receive medical coverage in the coming year.

But who’s going to treat them?

“It’s a big problem and there’s nothing in place to address that issue,” Dr. Kathryn Zerbach, a Santa Fe surgeon who specializes in the treatment of breast cancer, told New Mexico Watchdog.

According to the University of New Mexico Health Sciences Center, New Mexico is short an estimated 2,000 physicians and roughly 400-600 primary care specialists.

The problem is especially acute in sparsely populated counties in the southern and northwestern parts of the state. In 2006, more than half the physicians in New Mexico were located in the state’s largest county, Bernalillo County, where Albuquerque is located.

“The number of healthcare professionals and their maldistribution throughout the state cannot adequately meet current demand, let alone the additional pressures brought about by the newly insured in 2014,” a report from the Legislative Finance Committee warned.

Adding to the problem? New Mexico already has more older people than the general population of the United States:

older population in nm

“A lot of the hospitals in the state are trying to recruit (doctors),” Zerbach said. “The bigger hospital companies have more financial fortitude to do those kinds of things, but a lot of the smaller community hospitals really are struggling with that issue. And there’s nothing in place with the new health care law, or any of the things that are happening on the state level, that are going to fix that problem.”

Something’s got to give, and it seems a virtual certainty there will be longer wait times for patients, especially new ones.

“Most New Mexicans will likely feel the pinch of an inadequate healthcare workforce,” the LFC report said.

How long people will wait is hard to tell, but when Massachusetts reformed its health care system in 2006 average wait times for primary care and specialty care appointments exceeded 40 days, the report said.

Dr. J.R. Damron, a radiologist who serves as chairman of the newly-created New Mexico Health Insurance Exchange, concedes the problems will likely get worse as Obamacare rolls out.

“I think access to care is going to be a very big issue,” Damron told New Mexico Watchdog. “We can build this exchange, we can have the framework … but are we going to have enough health care providers to take care of those individuals?”

To help fill the need, some providers are already using nurse practitioners and physicians’ assistants to pick up the slack by having them take over some duties, such as conducting initial consultations with patients. That probably won’t sit well with patients who expect to see a doctor, not a nurse, to discuss their personal medical issues.

There are also programs in place requiring recent medical residents to work in New Mexico’s rural communities, but health care experts admit long-term solutions are needed.

To make things worse, nearly 40 percent of primary care physicians in the state are nearing retirement and there are fears there’s simply not enough young doctors to replace them.

“I think the medical profession is going to have to solve this problem,” John Franchini, the New Mexico Insurance Superintendenttold New Mexico Watchdog. “We can’t solve it from our end. We can’t demand that doctors don’t retire … Let (doctors) have more freedom to decide how to do this.”

Dr. Deane Waldman, a pediatric cardiologist in Albuquerque and the consumer advocate on the board of the New Mexico health exchange, suggests that hospitals and clinics could be encouraged to expand their hours, but admits that given a finite number of doctors, it will take an array of solutions to make a dent.

“The answer is, if we just keep doing business as usual we will not accomplish the goal,” Waldman said.

For now, there are suggestions and theories but not many specific programs to tackle New Mexico’s doctor shortage.

“It’s not being talked about and kind of being pushed under the rug for now because nobody knows what’s going to happen with (the ACA’s) complexity,” Zerbach said.

Here are excerpts of New Mexico Watchdog’s interview with Zerbach:


YouTube

Contact Rob Nikolewski at rnikolewski@watchdog.org and follow him on Twitter @robnikolewski

 

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Rob Nikolewski is the National Energy Corrrespondent for Watchdog.org. He is based in Santa Fe, N.M. Contact him at rnikolewski@watchdog.org and follow him on Twitter @NMWatchdog.

  • John Robert Small

    Hmmmm……anyone considering the cause? Ask a physician! !!!!

  • Cheryl Roberts

    OVERVIEW

    Among the Affordable Care Act’s many provisions, perhaps the least discussed are those reforms directly targeting primary care—the underpinning of efforts to achieve a high-performing health system. This brief describes how the health reform law will begin to address the decades-long neglect of America’s primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The primary care reforms in the Affordable Care Act include provisions for temporarily increasing Medicare and Medicaid payments to primary care providers; fostering innovation in the delivery of care, with an emphasis on care models that lead to better health outcomes and patient care experiences; enhancing support of primary care providers; and investing in the continued development of the primary care workforce (Exhibit 1). Together, these changes, if implemented effectively, will start the United States on the path to a stronger and more sustainable primary care system, one that provides expanded access, superior quality, and better health outcomes for millions of Americans while reducing future health care costs for the nation.

    Among the Affordable Care Act’s many provisions, perhaps the least discussed are those reforms directly targeting primary care—the underpinning of efforts to achieve a high-performing health system. This brief describes how the health reform law will begin to address the decades-long neglect of America’s primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers. The primary care reforms in the Affordable Care Act include provisions for temporarily increasing Medicare and Medicaid payments to primary care providers; fostering innovation in the delivery of care, with an emphasis on care models that lead to better health outcomes and patient care experiences; enhancing support of primary care providers; and investing in the continued development of the primary care workforce (Exhibit 1). Together, these changes, if implemented effectively, will start the United States on the path to a stronger and more sustainable primary care system, one that provides expanded access, superior quality, and better health outcomes for millions of Americans while reducing future health care costs for the nation.

  • Cheryl Roberts

    this is horse shit. period. here in texas, MOST of the state is a health professional shortage area. because of the affordable care act, we have increased the number of providers by 200% in texas already through the national service corps. further, the ACA adopted MOST of the recommendations of the American Medical Assocation that had been proposed as a federal bill in 2007 but failed. The ACA does things like increase the number of slots in medical schools and refocus the medical schools on primary care providers. Further it increases the pay of several groups of primary care providers. It has a system of loans and grants and further a system whereby if you agree to work in a health care shortage area, you get so much of your loan forgiven per year. STOP THE DAMN LIES. I AM A HEATLH CARE ATTORNEY AND CAN PROVE WHAT THE LAW SAYS AND WHAT I AM SAYING.

  • FreeMktMonkey

    One concern is that a reasonable reaction to Obamacare will worsen the doctor shortage even more. This is the movement gaining steam to sidestep all third party payment with direct care cash practices. Generally this is taking two forms, pay per use and concierge models. With concierge, patients pay a monthly fee for unlimited office visits. This model works great for doctors and patients who are always in the vicinity of the practice. Doctors can make more money by seeing far fewer patients and patients rarely have to wait long to be seen. The problem of course is patients who do not sign on to these agreements will have fewer doctors available from which to choose. Either pay per use or concierge direct care save the cost and burden of billing codes, pre-approval, collecting from the third party, compliance with medicare and Medicaid rules, among other things. Either allow doctors to do what they love to do without all the distractions of third party entanglements. Unless we can dramatically increase the number of primary care physicians, the concierge model has its unintended consequences.

  • SixSixSix

    So now the Right Wing says the ACA will succeed so brilliantly there will be a doctor shortage. Better we let more people die the Right Wing way and not bother. Brilliant. What was that thing – oh yeah, Right Wing Health Plan: Don’t Get Sick, and If You Do, Hurry Up and Die.

    Ever occur to you clowns that you are describing the problems of success? Generally it is better to polish off the problem brought on by success than court the pain of failure.

  • drtoes

    Cheryl, being from Texas I would expect you to be more able to recognize horse shit. The Feds have been adjusting the Medicare fee schedule for years by increasing payments for office visits and reducing surgical payments to benefit primary care practitioners…what the ACA does is nothing new. There are significantly less people applying to medical school now than there were 20 years ago, so creating more slots will only accomplish allowing people into school that wouldn’t have qualified 20 years ago…that will really help quality. What you say might be true…but it doesn’t help the situation. The problem with NM is that the education and work ethic are so pathetic that doctors won’t continue to practice when they can’t run an office and other health care facilities are staffed by incompetent people. Stop sticking up for a pathetic attempt to socialize our health care system and put it in the hands of more incompetent federal bureaucrats…and idealogues such as yourself that don’t have a clue about reality. BTW, I’m a doctor in NM.

  • sdhei

    It is academic how many doctors quit practicing since they have been ill-equipped by AMA and FDA approved and regulated medical schools to actually cure disease as opposed to selling expensive drugs that don’t cure anything and cause new symptoms for the doctor to treat, to earn his continuing education credits on luxury vacations. B17 is still the best cure for cancer.

  • sdhei

    Now I have yet another reason to never return to my native state, doctor.
    Are you the pot or the kettle?

  • sdhei

    The cause is iatrogenic.

  • drtoes

    Actually sir, from your other comments it sounds to me like you are the pot and the kettle…it’s people like you with your absurd attitude that make practicing medicine so difficult. Maybe you should go to Great Britain or France and see just how great their medical care is…and don’t get a serious illness. Don’t speak about something until you know what you are talking about…FDA approved medical schools, I can’t stop laughing about that one.

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