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The Health Care Crisis No One Is Talking About

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The Supreme Court has begun hearings on the constitutionality of the Affordable Care Act. Without a doubt, this will reignite a political firestorm -- and for good reasons. As a country, we are living with serious and divisive disagreements about the economics of health care. Who should pay, and who should not? How much should we be responsible for, and what are the limits of our fiscal responsibility? What should the financial relationships look like between citizen and government, between insurer and policyholder? These are pressing questions. Unfortunately, spiraling costs and diminishing returns are not the sole danger to our health care system. We are already in the midst of a crisis of health care infrastructure -- and by all projections, it is only going to get worse.

I am referring to America's doctor shortage. We simply do not have enough health care providers to meet the needs of our population.

The physician shortage problem is well-documented and should not come as a surprise to anyone. But while a scarcity of gasoline or smartphones would grip the nation, this far more dangerous shortage has drawn relatively little attention.

Just how bad is the problem? According to some estimates, the country was already lacking 20,000 doctors in 2010. By 2025, the gap could grow to between 140,000 and 214,000 physicians -- a deficit of 15 percent to 25 percent. If the Affordable Care Act is upheld, 32 million newly-insured patients will be in need of health care access while our doctor supply lags even farther behind.

Several factors will conspire to make matters worse. As baby boomers begin to retire in full swing and the American population ages, we will need steadily more health care. We are training a growing number of other medical professionals, like advanced practice nurses (APNs) and physician assistants (PAs), but not enough to cover the health care gap; APNs and PAs will also be in short supply.

Too few doctors are choosing to enter primary care as a result of economic pressures and for a number of other reasons. While the country will see a shortcoming of providers in almost every specialty, we will probably feel it most acutely in our lack of family physicians -- professionals we rely on for the routine, preventive care that is worth so many pounds of cure.

The doctors we do have will continue to cluster in cities for both economic and cultural reasons. If you live in rural U.S., there is a good chance you are in a de facto health care desert. And wherever you live, it is likely that this issue has already affected you personally -- even if you didn't realize it at the time.

According to a study by the health care search and consulting firm Merritt Hawkins, the average American must wait nearly three weeks to see a doctor. That is long enough for a small, avoidable health issue to become a full-blown crisis that could land you in the emergency room, where health outcomes suffer and costs spike dramatically. In some cities, wait times approach a staggering two months.

Clearly, the doctor deficit is not a problem with a simple fix. The issue is extremely complex, with social, political, and economic factors to be considered. But stepping back for a moment, every solution can be boiled down into one of two buckets: We can train more health care providers, or we can use the health care providers we have more efficiently.

There are various ways to train more doctors. In 1997, the government imposed a cap on the number of federally-funded medical residencies. Lifting this cap to allow more doctors through training is probably the most widely-discussed solution. Unfortunately, this sort of solution does not pay off overnight. It takes 11 years to fully educate a doctor (and at least three just to complete residency). Even if we implement these changes today, we will only protect ourselves from the worst of the crisis, years down the road.

But what about the second set of solutions? How can we use our current medical labor force more efficiently? I am happy to report that a number of health care IT firms are taking up this problem by helping providers communicate with their patients more rapidly and use patient records more seamlessly. My own company is making appointment scheduling simpler and more flexible, thus reducing wait times and improving health outcomes. The field is a promising one and worthy of far more attention than we are currently giving it.

Consider the changes we have seen in travel, education, music, and commerce during the last decade. The information era is just dawning, and many industries have already been reinvented. Although health care has lagged behind in many respects, we are beginning to see how it might be transformed by the speed, power, and efficiency of the Web. It is time to redouble these efforts and make the simple improvements that are within reach.

Again, we are all familiar with the health care reform debate. We know how combative and factious it can be. In my view, the greatest risk posed by such a debate is one of distraction. Health care economics are profoundly important, and the Supreme Court ruling on the Affordable Care Act will hold enormous implications for our country's future. But the problem of doctor shortage is even more fundamental, and it will persist -- regardless of whether or not the bill is found to be constitutional.

The best way forward is to make this issue a centerpiece of the looming national discourse. The good news is that there is simply no room for dissent when it comes to building an adequate infrastructure. We can all agree that we need roads, power lines, and plumbing. And regardless of where we stand on the government's role in medicine, we can all agree that we need more clinicians. In other words, we have identified the problem. Now, in the best spirit of American ingenuity, let's come together to solve it.

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