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Dr. Jon LaPook

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Who Will Take Care of 32 Million New Patients?

Posted: 03/25/10 01:59 PM ET

With the passage of health care reform, an estimated thirty two million new patients will try to find primary care doctors. That's not going to be so easy because we already face a shortage of primary care doctors and about 13,000 more will be needed to take care of those newly eligible for insurance.

According to the American Medical Association, there are about 312,000 primary care doctors practicing in the United States. That includes family medicine, general practice (GP), internal medicine, and pediatrics (in addition, there are 43,000 ob-gyn's, who also may serve as primary care doctors). The estimate that another 13,000 will be needed comes from a study done by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in partnership with the Agency for Healthcare Research and Quality.

Sixty five million Americans already live in areas that don't have enough primary care doctors. And relief is not on the way anytime soon. It takes 5 to 8 years for a first year medical student to be trained as a primary care doctor. And the trend for budding doctors over the past decade has been away from primary care and towards more lucrative specialties.

The new legislation contains some incentives for entering into primary care. Medicare will pay a ten percent bonus to doctors spending most of their time giving primary care to the elderly. Medicaid payments will be increased by about 20 percent in 2013 and 2014 to reach 100 percent of the Medicare rate. This is important because about 16 million new patients will be eligible for Medicaid and many doctors currently don't accept Medicaid because reimbursement is so low. In addition, primary care doctors will be paid extra for coordinating care among a team of doctors.

The new incentives are a good start but more is needed to increase our supply of primary care doctors. For this week's CBS Doc Dot Com, my producer, Heather Tesoriero, and I traveled to a rural community in Indiana and discussed the shortage with an old-fashioned family practitioner named Dr. Jason Marker. When he started practicing eight years ago he was $140,000 in debt from medical school loans. He works long hours and sees about 100 patients a week but still owes $125,000. But Dr. Marker isn't in it for the money and he's not looking to heal only the well-heeled. The day we visited him, a man walked five miles to his office from a homeless shelter. When I asked Dr. Marker what keeps him going after a rough day, he admitted that sometimes he wondered if it was all worth it. But then he added, "And then you go into the next room and you have a little old lady give you a big hug and you're ready to go again."


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Please click here to watch my interview with Dr. Marker.

 
 
 
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02:16 PM on 04/06/2010
All of these articles often off-handedly mention that medical students are increasingly seeking specialty training, without ever asking why that is. This increasing imbalance between specialty services and primary care is a huge problem, and its root are very deep in the American medical system. The reasons are many: Primary care doctors no longer feel ownership of their practice; there is so much red tape and paper work that their medical training feels somewhat secondary to their ability to push paper. Yet, talk to your average American health care consumer about their doctor, about their perception of what he does day to day, why he is late, etc and you'll often get a shug. No wonder that medical students (who after four years of college go though seven to twelve extra years of training) do not want to end up working low hours with minimal pay and with very little appreciation (at times). So what's the solution? Adopt a system that recognizes the importance of primary care, that focuses on prevention and that allows doctors to work with their patients primarily, not their insurance companies. Doctors, and medical students, deserve some credit too.
05:47 PM on 03/26/2010
Unbelievable. Who's taking care of these people now? They may not have health care insurance but I betcha some of them actually have had medical treatment. Stupid argument made by the doctor.
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Jaczar
Humanity above Profit
05:45 PM on 03/26/2010
Well, doctor, try hiring some nurse practitioners and physician's assistants to help handle the load, they're excellent and patients love them.
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DrLaPook
Medical Correspondent, CBS Evening News with Scott
06:22 PM on 03/26/2010
To Jaczar and others who have brought up the fact that there are other health care providers aside from physicians who provide excellent care. I totally agree. I was trying to keep the blog focused on the shortage of physicians but your points are very well taken. I work closely with a nurse practitioner who is absolutely terrific. In fact, an episode of CBS Doc Dot Com about nurse practitioners is already in the works. So thanks for your comments!

Best,
Jon LaPook
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05:33 PM on 03/26/2010
Does anyone really have a shortage of doctors, primary or otherwise? They are tripping over each other here, can walk into just about any office in town with an hour's notice and be seen.
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Ace News Services
04:05 PM on 03/26/2010
The fact that over a number of years the US like other countries of the world have with the advent of Private Healthcare for the rich and people in full employment cut-back on primary care practioners. The advent of this bill has brought about a lack of and now the need for more people to have been trained in the past. But like the UK the financial services industry had become a way to make easy money and all people have to do was borrow. This was not putting people first but themselves and now we and the US need to reinvest in healthcare and it will take a longer time and a burden of the small majority of practioners will be put under pressure, so l hope and pray that people will not suffer from the mistakes of years of putting profit first and people second.
02:17 PM on 03/26/2010
The next reforms need to deal with the cost of college and medical school. We need more physicians and the best way to get them into low profit areas of medicine like being a general practitioner is to have the taxpayer fund the cost of their medical school, put them on a salary when they graduate, and even pay to set up their office.

In the short term what I think will happen is we'll attract doctors from overseas who will go to all these medically underserved areas. Good for us but bad for their home countries.
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Jaczar
Humanity above Profit
05:50 PM on 03/26/2010
Uh, Robert, some are good, some are not. Try to get some non-english as first language doctors to understand what you tell them, especially the nuanced speech and symptoms, then try to understand what they tell you. Give me a nurse practitioner or physicians assistant from the U.S.
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TXfemmom
Grandma with eye on the future
02:10 PM on 03/26/2010
The government is going to have to finance the education of physicians with primary care origins and in large numbers in the next four to six years. Remember, the government highly subsidizes medical training already, as much of the cost of medical schools comes from federal funding, and virtually all the cost of internships and residencies, to train specialists, is FULLY FUNDED BY MEDICARE AND THE GOVERNMENT. Yes, folks, those doctors are PAID SALARIES from the GOVERNMENT, YEEKS SOCIALIZED PROGRAMS, along with healthcare and other benefits during their intenships and residencies, and their medical school are highly subsidized as well.

In return for this further subsidation of their studies, individuals could be encouraged to enter primary care.
04:42 PM on 03/26/2010
The last time the government spent to help educate a new generation of physicians (around the time of Medicare passing in mid-60s), they largely went off and became specialists. I hope they follow your advice this time around.
11:29 PM on 03/26/2010
as they said, the funding of residencies is currently through medicare. they have tried for years to encourage primary care and they have and will continue to fail. the model is in need of a major overhaul. we need to focus on practice extender training as primary care providers and physicians as specialists
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Salukeitis
02:06 PM on 03/26/2010
It is correct that we the USA does not have enough MDs. Ask yourself "Why is that?. Who determines how many doctors will be graduated per year? Why are foreign doctors getting a foothold in too many places/
Years ago I read a book by Martin Gross "The Doctors". In it he states the AMA is purposely holding down the number of MDs for MONEY reasons. It is true the AMA hasn't stepped up the number of doctors graduating each year. There is no planning. No thought of current and future needs. Only the almighty dollar. Don't put more doctors into the market We The MDs want to make hundreds of thousands of dollars.
Now that universal health care is coming the MDs are "squaking"not enough doctors.
Capitalism does not plan. It only Rumbles and gets what it wants there and then.
Banksters and Wall St may indeed be shaping their demise, 2012 might be it!!!!
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02:16 PM on 03/26/2010
You are correct. My primary care M.D. charges about $80 for an office visit.

The "specialists" he has referred me to.... want about $140.
03:02 PM on 03/26/2010
Do you honetly believe there is any capitalism left in this country?
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Salukeitis
03:47 PM on 03/26/2010
mac are you for real, Wall St and the Banksters rule. Oh you mean other than them?
And yes these cheaters are relly socialism for themselves only-they compete with no one
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02:01 PM on 03/26/2010
Reading the Health Insurance Reform bill or going to Senator Bernie Sanders website would be a fine idea for understanding what has just been enacted into law.
$10 billion allocated over five years to expand, construct, and operate community health centers.
Increases investment in National Health Service Corps to train more primary care doctors as well as dentists and nurse practitioners.
$2.5 billion for health centers operations (including dentistry, low-cost prescription drugs, and mental health care.)

Over the next five years, community health centers will grow nationally from 7,500 to 15,000.
Patients served by the community health centers will grow from 20 million today to 40 million by 2015.

$1.5 billion alloted for loan repayments and scholarships will add more than 17,000 primary care doctors, nurse practitioners, physician assistants and mental health professionals in medically underserved areas -- which is a critically important improvement!

These are excellent first steps in improving our health care .... more ought to be written about the facts!
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TXfemmom
Grandma with eye on the future
02:11 PM on 03/26/2010
Thanks for the information
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Bill Mynatt
01:34 PM on 03/26/2010
The offensive premise of your article is that they should not receive care. Aside from the fact that any nurse or worker in any ER in the US can tell you where they HAVE BEEN receiving care and who has not been paid for it, your question suggests that if they cannot pay, they are not a problem. That is either dumb or recklessly mercenary with American health.
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Rubyfoo
01:31 PM on 03/26/2010
Hey I got an idea Jon. Why don't you docs get off the money train and join clinics like Kaiser Permanente, which can provide services much more efficiently that your little one off thingies.
01:22 PM on 03/26/2010
"Who Will Take Care of 32 Million New Patients?"

You mean the Big O didn't think of that before introducing the HC bill? Uh-oh.
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01:21 PM on 03/26/2010
There seems to be plenty of "resources" available to pay private-contractor mercenaries to carry on warfare around the world so why no resources for healthcare?
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sak
01:35 PM on 03/26/2010
You are so right. We have plenty of money, tons of it to produce weapons and pay criminal contractors out to fight for Jesus, but for health care? Forget it.

How about this. Provide free education for anyone who wants to go into the health care professional for the next ten years - doctors, nurses, etc. That might be a great way to kick start the system because we may have an overcrowding issue at first. On the other hand, lots of the new insured will be young people who probably will not need a lot of care.
12:48 PM on 03/26/2010
The healthcare model that we should be looking at to take care of 32 million added patients is the non-profit, Kaiser Permanente . Not only have they totally automated their patient healthcare records, and their entire administrative, hospital and pharmacy systems(saving millions),but they have fostered a state of the art preventative healthcare program,which in the long run will save them billions in healthcare costs. Kaiser also refers patients to outside specialists, when they can not handle the medical treatment themselves. They are ready and capable of adding a large number of patients. There has been steady primary care physician growth at Kaiser. Many private physicians, weighed down with office and insurance costs, are opting out to become Kaiser physicians. Yes they will have heavier patient loads,but they won't have to pay admin staff, malpractice insurance, and be accountable to other HMO and PPO plans. Is its a perfect system? Of course not. There are horror stories in every healthcare system, but this HMO system is music to the millions who use it, and the HMO, Kaiser-like models that follow will be able to carry the load.
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Jaczar
Humanity above Profit
06:05 PM on 03/26/2010
Forget Kaiser and model after the Cleveland Clinic or the Mayo Clinic who give top care at reasonable rates. Their physician staff is salaried and caring and their vendors bid for the right to sell them supplies and drugs. Not-for-profit health care at it's best.
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etiennemacchias
Thinking is anathema to religion.
12:46 PM on 03/26/2010
Let's take a look at the basic economic principle, shall we?

If you draw a Supply and Demand curve, and shift the D curve to the right, the S will rise. Over time, the S curve will also shift to the right until the two coincides at an equilibrium. It's simple as that; there's no need for worrying.
01:24 PM on 03/26/2010
It's really not as simple as that. What you described is only true in a perfectly competitive market. However, in this case, it ignores the huge impact of regulation, price controls, barriers to entry (in the form of what it takes to become a doctor... it's not like just going out and finding another 10,000 people to dig ditches...), risk/reward implications of malpractice exposure, the disincenting impact of higher marginal tax rates, etc. etc.

Glib is easy. Real solutions are not.
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etiennemacchias
Thinking is anathema to religion.
02:17 PM on 03/26/2010
You got me there. But do remember, America is a laggard in this health care reform compared to many of the other developed countries. If others can cope, we can as well.

The bill does portend some major setbacks and hindrance in our immediate future, but things will stabilize over time. I foresee an increase of interest of students in the medical professions and growing medical schools. Things will work out; trust me.