Monday, September 23, 2013

Another Joy Of Obamacare: Primary Care Doctor Shortages

I'm sure that this is an unintended effect of the so-called Patient Protection and Affordable Care Act that there would be primary care doctor shortages, right?
I guess so since this article suggests that in the United States there needs to be 40,000 new primary care doctors just to maybe ease a shortage of said doctors as the implementation of Obamacare becomes a reality.
A little lesson in logic before I move on.
Again, you can not expand the pool of people that will be insured, offer supposed quality care without enough PCP (bad acronym, I know) to take care of said newly insured people.
Logic and liberal left Democrats, does not exist.
I guess that people who go to medical school should probably not bother to go into speciality fields where they may actually make money. That is probably what the liberal left Democrats will do next to make sure that there is not a shortage of PCP.
The PCP is the one that we just used to call the family doctor. You know if you are old enough that sometimes back in the day, many would actually come to one's home. Thus the expression about doctors making house calls.
Those days are long gone.
But the PCP today is what they are called. It is who we all go to when we have a medical problem to have an assessment. The PCP will do what he or she can and often refer patients to specialists that will be able to better treat said patients for long-term medical problems.
But there are not enough of these PCPs and one reason is simple.
They do not get good reimbursement from insurance companies and will more than likely get even less under Obamacare.
The PCP in the linked story, Dr. Reed Wilson, points this out.
The average debt for a PCP once they attain the necessary loans and complete their studies is a staggering $170,000 before they see one patient.
Thus a student needs to make a decision before they walk into medical school. And that is what field will they study. And now more than ever they are going into speciality fields because that is where the money is. And where the money is will pay off the loans that they had to take out to go to medical school in the first place.
So what to do about the problem?
Well, leave it to the liberal left Dems to come up with a solution in  nurse practitioners being allowed a greater role in patient care.
That is the "solution" put forth by state senator Ed Hernandez, an optometrist.
As Dr. Wilson pointed out NPs are great for the basics. And I agree. Many nurses when it comes to the basics are very good. But for actually diagnosing patients the way that a PCP does, uh not so much.
To state Sen. Hernandez, don't address the real issue. And that is PCP shortages and or compensation, but throw out something that has a less paid, educated and trained person as a nurse practitioner to help, supposedly, ease doctor shortages.
If I went to Dr. Hernandez for eye care, would he let one of his assistants complete an eye exam and determine my eye-care needs?
I don't think so.
One aspect that the article did not address is that there is a growing amount of PCPs that are getting out of the insurance business and not accepting insurance patients. They are essentially seeing patients and only take cash for that. And a lot of people that can afford it are seeing these doctors. Is that a possibility as to why there are real doctor shortages in not just California but the United States as a whole?
So how much does a PCP make in comparison to specialists?
This link, while outdated by a year, illustrates that there is a serious divide.
Here is what the umbrella of PCPs made on average in 2012:

  • Pediatricians: $173,000 (up from $156,000 a year before)
  • Family medicine doctors: $175,000 (up from $158,000)
  • Internal medicine doctors: $185,000 (up from $165,000)

  • Oh, I know that sounds like a lot of money. But between repaying student loans and medical malpractice insurance and taxes, it is not all that much for someone fresh out of medical school. Remember this is an average and that a rookie PCP probably makes nowhere near this kind of money.
    And specialists?
    Here are what some specialists make in a year:

  • Dermatologists: $306,000
  • Plastic surgeons: $317,000
  • Urologists: $340,000
  • Radiologists: $349,000
  • Cardiologists: $357,000
  • Orthopedists: $405,000

  • So if I were thinking of becoming a doctor and looked at who makes what, I would more than likely consider a speciality over being a gatekeeper, which is what a PCP has become.
    A PCP does a lot of work and really gets the shaft.
    Yet they are the bulwark of the totally misnamed PPACA.
    Dr. Wilson makes the obvious point that we will not attract good PCPs if there is not adequate compensation. And another fact that is truly disturbing is that only 30% of PCPs actually own their practice. In other words 70% of PCPs work for insurance companies and or medical groups.
    And I let Dr. Wilson explain the obvious:

    “I love taking care of patients. I’m in an area where I can take time with my patients. But how do you get the best and brightest if you don’t reward them?”

    Yes, how do you do that? And how does Obamacare keep medical costs down while supposedly providing healthcare to all Americans?
    It does not and it really counts on the PCP shortage to keep costs down.
    And that is a scam if ever there was one.

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