The Affordable Care Act’s insurance expansion is about to take effect and the U.S. currently has 15,230 fewer primary care doctors than it needs according to the Department of Health and Human Services. The Association of Medical Colleges predicts that the shortage of primary care and specialty physicians will climb to 130,000 by 2025.
Obviously increased demand is driving the need for more doctors but there’s another aspect that is less talked about and if you are a conspiracy theorist you might wonder if it’s really even an accident.
Residency programs to train new doctors are largely paid for by the federal government, and the number of students accepted into those programs has been capped at the same level for the past 15 years. Medical schools are not able to expand because the number of applicants for residencies already exceeds available residency slots.
The factors limiting output of new doctors will have an impact on efforts at health care reform and doctor shortages will continue to grow because of increased demand on the system as millions of people become eligible for health care coverage. Doctor shortages that currently affect rural areas like Clinton and Mid-Missouri will spread to all parts of the country in the coming years. Patients will most likely have to wait to see a doctor, if they can find room at all, undermining the prospect of reducing health care costs through increased preventative care.
It would make sense to just increase the number of residency slots so that medical schools could increase enrollment but it costs almost $145,000 per year to train one resident. The federal government currently pays teaching hospitals to train residents but the purse strings in Washington are tight and the debt reduction plan of 2010 calls for $6 billion in cuts to teaching hospitals. Teaching hospitals aren’t going to add residency slots if each slot losses money.
A conspiracy theorist would draw the conclusion that increased demand and fewer doctors is a form of rationing and that rationing is the tool the ACA will use to decrease health care cost in the U.S. A realist, like me, will draw the conclusion that we are going to have to find ways to see more patients with fewer physicians.