Monday, June 2, 2008
Lets Learn from Massachusetts
Taking a bold step, Massachusetts decided to cover all its residents with universal healthcare in 2006. It is not a surprise to many of us (and certainly not to the medical bloggers out there) that they soon ran into a problem with primary care access. The community clinics have hundreds of newly insured patients on wait lists of two to four weeks to see a primary care physician.
Making matters worse, the clinics cannot recruit primary care physicians and have had openings for over two years. "What Universal Care has done is highlighted the crisis and the problem that we have with the primary-care workforce," said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week.
I believe we cannot even begin to talk about health care reform until we make sure all citizens have health coverage. That is called "Universal Coverage" and Massachusetts has proven it can be done. But we must also address workforce shortages that will make access a huge problem if we start covering uninsured patients. It is not either/or. These issues go hand-in-hand and we must begin now.
As I have said before, it takes about ten years to restore the training pipeline for doctors. Medicare has a totally wacky payment system that disadvantages primary care and the insurance companies follow the same rules and codes, compounding the problem. The workload is no longer tolerable and the reimbursement is failing to keep up with practice expenses. Established primary care doctors are retiring early or limiting their practice to patients who pay a retainer. New doctors are shunning this specialty and we can't even import enough foreign medical graduates to fill the gaps. This impacts everyone with insurance...before we even add in the 45 million uninsured.
This country really has its head in the sand when it comes to health care and planning. What I am suggesting is not radical, but it does take vision and effort in Washington. Let's hope the next President will get good advice and start tackling these basic issues before enacting reform.
Posted by Toni Brayer, MD at 1:20 PM