Obamacare Worsens U.S. Doctor shortage (Physician shortage is growing)!

Doctor Shortage Likely to Worsen With Health Law

By ANNIE LOWREY and ROBERT PEAR

NY Times Aug 28 2012

Published: July 28, 2012

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42% in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.

But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.

A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.

Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.

Providers say they are bracing for the surge of the newly insured into an already strained system.

Temetry Lindsey, the chief executive of Inland Behavioral & Health Services, which provides medical care to about 12,000 area residents, many of them low income, said she was speeding patient-processing systems, packing doctors’ schedules tighter and seeking to hire more physicians.

“We know we are going to be overrun at some point,” Ms. Lindsey said, estimating that the clinics would see new demand from 10,000 to 25,000 residents by 2014. She added that hiring new doctors had proved a struggle, in part because of the “stigma” of working in this part of California.

Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.

“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.

Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.

But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.

Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.

Dr. Smith said building more walk-in clinics, allowing nurses to provide more care and encouraging doctors to work in teams would all be part of the answer. Mr. Corcoran of the California Medical Association also said the state would need to stop cutting Medicaid payment rates; instead, it needed to increase them to make seeing those patients economically feasible for doctors.

More doctors might be part of the answer as well. The U.C. Riverside medical school is hoping to enroll its first students in August 2013, and is planning a number of policies to encourage its graduates to stay in the area and practice primary care.

But Dr. Olds said changing how doctors provided care would be more important than minting new doctors. “I’m only adding 22 new students to this equation,” he said. “That’s not enough to put a dent in a 5,000-doctor shortage.”

Annie Lowrey reported from Riverside, and Robert Pear from Washington.

Obamacare does not cover patients with pre-existing conditions

My dad is a retired Army Sergeant, and retired School teacher, and a Medicare recipient.  Under Obamacare he will be losing one or all of his earned Medical Coverage’s (Tricare, Blue Cross, or Medicare). That’s the bottom line! Obamacare will be directing him into a “State Exchange”.

The Pre-Existing Condition' Hoax in ObamaTax

Thank You Brietbart News!

We are told that one of the most “popular” features of the president’s signature “ObamaTax” health insurance law is one that prevents health insurance companies from denying coverage to those with pre-existing conditions.

We are told that the ObamaTax will protect Americans with pre-existing conditions from nasty big health insurers, while Republicans and conservatives shrug their shoulders in “let them eat cake” fashion. Forget about the fact that the premise of the left’s presentation is totally false, as it often is, since big health insurers and hospitals are loving ObamaTax because it will channel federal funds right to their doorsteps.

The truth is that, while a definite problem has prevailed for those with pre-existing medical conditions who have attempted to obtain health insurance coverage, that problem is small and manageable and can be adequately addressed with common-sense free market solutions. Most people, regardless of political ideology, want all Americans to be able to purchase health insurance coverage and gain access to care. The difference is not in the desire but in the policies that will get the job done. Neither Republicans nor Democrats have been successful in this endeavor to date.

With ObamaTax, the left has chosen a big government policy that will offer a very brief period of health care access to individuals with pre-existing conditions, followed by little or no access to care as Americans cope with long lines to see doctors. They will soon face an Independent Payment Advisory Board (IPAB), a group of unelected government bureaucrats, who, as their name says, will be more concerned with payment than health care.

The “pre-existing condition” feature of ObamaTax is, indeed, a hoax, because it assumes that, once the law is fully implemented, those with pre-existing conditions will still be able to schedule an appointment with their doctors and specialists within a reasonable period of time. The law assumes this despite the fact that, at full implementation, all the currently uninsured will be added to the rolls as patients to the health care system.

Consider that a recent survey, released by the Doctor Patient Medical Association, found that 83% of American physicians have considered leaving their practices over President Obama’s health care reform law, and 72% say the individual insurance mandate will not result in improved access to care. In addition, 74% of the physicians surveyed say they will stop accepting Medicare patients or leave Medicare panels completely, while 49% indicate they will stop accepting Medicaid patients.

What this means is that the number of doctors available--the supply of physicians--will likely decrease as the demand for services increases. Sure, you might be able to see a nurse practitioner for a cold or cough, but the wait to see a specialist for those “pre-existing conditions” will seem like an eternity.

In addition, those with serious pre-existing conditions who require a substantial amount of medical care will need to keep in mind that, once the IPAB is activated, their ability to obtain the access to care they need will be determined by this board of government bureaucrats. To be blunt, the IPAB will decide if it’s worth it for funds to be spent on care for someone who requires much of it yet may never get well, as opposed to someone who is likely to recover and be “useful to society.”

Let’s look at the situation of parents who have a child with special needs. Though supporters of ObamaTax will say that a child with a pre-existing condition is automatically entitled to health insurance coverage, the fact is that, when the law is fully implemented, limitations will be imposed on Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs). Since the demand for the services of specialists will increase dramatically, gaining access to the supply of care needed will grow difficult.

A more common-sense approach to ensuring that all Americans, even those with pre-existing conditions, get access to the health care they need is to repeal ObamaTax and make several simple changes to our health care system by removing the pre-Obama obstructions.

A relatively easy thing for Congress to do is to extend tax credits, now given to employers who offer health insurance plans to their employees, to individuals who purchase their own health insurance instead. This would open up competition among health insurers for clients and end the current system of employers having to choose health insurance plans for their employees. As it is now, with ObamaTax, many employers are dropping health insurance coverage altogether, forcing individuals into the state “exchanges.”

Second, Congress should expand and strengthen the use of Health Savings Accounts (HSAs) to put more health care purchases of goods and services in the hands of consumers. The United States should be on a path to personal ownership of health insurance plans--a goal that would eliminate the need to apply for new health insurance coverage when people switch jobs, move, etc. Notice that ObamaTax, or government ownership, is the polar opposite of personal ownership of health insurance.

We have heard it all before, but allowing purchase of health insurance across state lines would open up competition and lead to health insurers seeking out customers, offering the best deals for the best plans. As a result of increased competition, Americans would also likely see new start-up health insurers that would find this business to be worthy of risk.

For doctors to be able to participate in the free market relationship with their patients, tort reform is essential. The costs of malpractice insurance can be a deterrent for many who might otherwise consider a career in medicine.

Finally, we will always need a high-risk pool with government subsidies available for the seriously ill. But, we cannot maintain this system without solid checks on application criteria to ensure that it is not abused.

Members of Congress who pledge to repeal ObamaTax must also pledge to make sure our health care system is not ripe for government takeover again. Yes, everyone, even those with “pre-existing conditions” should be able to obtain health care coverage. What ObamaTax does not guarantee is health care access.

Canadians Come to The U.S. for Medical Care...Where will Americans go?

Hey….Where will Americans go to flee once Obamacare is enacted? With Canada out as an option and Mexico…well you know Mexico isn’t an option, what do Americans do for treatment?

Report: Thousands fled Canada for Healthcare in 2011

Published: 3:17 PM 07/11/2012

By Michael Bastasch

H/T The Daily Caller!

A Canadian study released Wednesday found that many provinces in our neighbor to the north have seen patients fleeing the country and opting for medical treatment in the United States.

The nonpartisan Fraser Institute reported that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent — more than double — compared with statistics from 1993.

Specialist physicians surveyed across 12 specialties and 10 provinces reported an average total wait time of 19 weeks between the time a general practitioner refers a patient and the time a specialist provides elective treatment — the longest they have ever recorded.

In 2011, Canadians enrolled in the nation’s government-dominated health service waited long periods of time for an estimated 941,321 procedures. As many as 2.8 percent of Canadians were waiting for treatment at any given time, according to the Institute.

“In some cases, these patients needed to leave Canada due to a lack of available resources or a lack of appropriate procedure/technology,” according to the Institute. “In others, their departure will have been driven by a desire to return more quickly to their lives, to seek out superior quality care, or perhaps to save their own lives or avoid the risk of disability.”

Increases in the number of patients leaving Canada for treatment were seen in seven of the ten Canadian provinces: British Columbia, Saskatchewan, Manitoba, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador.

“Some of these patients will have been sent out of country by the public health care system due to a lack of available resources or the fact that some procedures or equipment are not provided
in their home jurisdiction,” the report concluded.

“Others will have chosen to leave Canada in response to concerns about quality … to avoid some of the adverse medical consequences of waiting for care such as worsening of their condition, poorer outcomes following treatment, disability, or death … or simply to avoid delay.”

Canada’s median wait time for treatment after consultation with a specialist also increased in 2011, from 9.3 weeks to 9.5 weeks. The Fraser Institute’s report concluded that the nation’s doctors don’t like the status quo any more than their patients..

“[P]hysicians themselves believe that Canadians wait nearly 3 weeks longer than what they consider is clinically ‘reasonable’ for elective treatment after an appointment with a specialist,” according to the report

Each year the Institute conducts a survey asking doctors across 12 major medical specialties in Canada what percentage of their patients have received non-emergency care outside of Canada in the previous 12 months. In 2011, approximately one percent of all Canadian patients were estimated to have received non-emergency care outside their home country.

Obamacare has Physicians considering leaving the profession of caring!

Doctors are driven, intelligent, caring professionals. The People who work for the Division of Motor Vehicles are not driven, they are not intelligent, and they could give a crap less about your health. Physicians do not want to be associated with DMV…Obamacare would make physicians DMV workers (and patients the people waiting on line)!

Report: 83 percent of doctors have considered quitting over Obamacare

Published: 2:20 PM 07/09/2012

By Sally Nelson in the TheDC

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.

The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

Even if doctors do not quit their jobs over the ruling, America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65.

By 2025 the shortage will balloon to over 130,000, Len Marquez, the director of government relations at the American Association of Medical Colleges, told The Daily Caller.

“One of our primary concerns is that you’ve got an aging physician workforce and you have these new beneficiaries — these newly insured people — coming through the system,” he said. “There will be strains and there will be physician shortages.”

The DPMA found that many doctors do not believe the Patient Protection and Affordable Care Act will lead to better access to medical care for the majority of Americans, co-founder of the DPMA Kathryn Serkes told TheDC.

“Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,” she said.

The American Medical Association, which endorsed Obama’s health care overhaul, was not able to immediately offer comment on the survey. Spokesperson Heather Lasher Todd said it would take time to review the information in the survey.

Janelle Davis of the American Academy of Family Physicians said the AAFP could not provide thoughtful commentary without studying the survey’s findings and methodology.

Obamacare...Some Government Employee (a non-Physician) will decide when you can (and to what level) have treatment!

From The American Thinker  

June 30, 2012

A Surgeon Cuts to the Heart of the ObamaCare Nightmare

By Stella Paul

 

The day the Supreme Court ruled in favor of ObamaCare, a friend called me. He's an extremely dedicated, much-loved surgeon, and he was frustrated and livid in equal measure.

"I've actually had a lot of experience working in all different types of environments," he began. "I've worked in a government-run socialized medical care system, and I saw the waste and inefficiency.

"The longer people worked in that system, the less work they wanted to do, because the more you wanted to do, the more they dumped on you. So after a while you stop doing it, because they're not paying you to do more. Why should you do a difficult case, a difficult surgery that will take you hours and hours to do?

"You might start out wanting to do it, but after a while, you just run out of energy, because there's no incentive. You'd have to be a superhuman being to continue to work in that system and not be worn down by it.

"Because nobody wanted to work, it would take an hour to turn over the surgical room. In my private practice now, it takes ten minutes.

"And I saw tremendous waste: closets of stuff that never got used. Nobody cared.

"Capitalism has completely transformed my sub-specialty. When I was in training, a common procedure that I do now took 40 minutes, and people needed a month of recovery. Now it takes 10 minutes, and people can go back to work almost immediately.

"And all these improvements were driven by the financial incentive. Capitalism has had a tremendously positive effect on patient care and outcome in my specialty.

"But when I go to meetings now, I see that there's very little innovation going on. Everything's being impacted by ObamaCare, which, among other things, raises taxes on medical devices.

"You know, doctors are people, and we're being hammered on all sides here.
It's the paperwork; it's insurance; it's transitioning to electronic medical records, so the government can get their mitts into your practice. It's lawsuits; it's rising overhead and decreasing compensation; it's stress upon stress upon stress.

"And a lot of doctors are going to say, 'Forget it. I don't want to do this anymore.' Guys that are 5 or 10 years older than me are just going to give up and walk away.

"Why should I be a slave to the government? You know, it used to be that doctors would do charity work at a charity hospital. Nobody wants to do it anymore, because we're too overwhelmed.

"I work 60 to 70 hours a week, so how am I supposed to fight back against this? Most doctors don't have the time to lobby their congressman or go to Washington. If you're a doctor in the trenches, you've got a stressful job; you've got a family. You're seeing the same number of patients and making half the income you used to make. People are litigious these days, so you've got to worry about lawsuits. When are you going to find time to lobby a politician?

"And the American Medical Association threw us all under the bus, even though only 18% of doctors belong to it. These people are ivory-tower academics, and they're liberals. Most of them are in academic medicine; they get a salary with some sort of incentive bonus. They show up to work and go home. They're not in the trenches like me, figuring out how to compete with other doctors and pay for malpractice insurance and how to hire four people I need to implement the electronic medical records and two people I need to deal with insurance.

"And as a doctor, I get it handed to me both ways. My taxes are raised, and my fees are lowered.

"You know, young people today who go to medical school -- I don't know what to tell them. You couldn't pay me to go to medical school today. Some doctors are going to graduate with $500,000 in debt, and how are they going to make a living?

"You're 32 or 33 years old by the time you finish your training; you're married with little kids. You've been an apprentice for 16 years, and now you're faced with socialized medicine. That's the reality on the ground. How are you supposed to manage that?

"Fortunately, I still love what I do. But I don't know what's going to happen. I think we'll wind up with a two-tiered medical system: a private one for the rich who pay cash and a mediocre one for everyone else.

"When my dad was 91, he had a heart attack and ended up with a stent. He had two more good years after that before he died. After ObamaCare, some government employee is going to decide that he is too old for this and not 'approve' for him to have that procedure.

"It's just a feeling of helplessness. The only organizations that are fighting for doctors are the Association of American Physicians and Surgeons, and Docs4 Patient Care."

After he hung up, I went to the website of Docs4 Patient Care and found this statement from its president, Dr. Hal Scherz:

The Supreme Court disappointed the majority of Americans who have voiced their opposition to Obamacare, by upholding significant portions of this truly abysmal law. Their decision has left Americans now wondering what it is that the Federal Government can't compel them to do. This is perhaps the worst decision in the history of the Supreme Court and emphasizes the importance of making the correct decision for chief executive, who controls who sits on this bench.

If you want to cure the sickness that's killing America, you'll find a powerful remedy in the voting booth in November.

Obamacare taxes our Employer group policy out of existence. Obamacare taxes our private health insurance, and employers will simply end this benefit!

Obamacare calls it "Cadillac" health insurance, but you and I call it our employer group policy that our employer extends to us as a benefit! YOU KNOW THIS IS BAD WHEN THE DEMOCRATIC SENATOR JAY ROCKEFELLER says it B A D!!!

Starting in 2013, there will be an Obamacare tax on medical devices such as intra-uterine devices, artificial hips, heart pacemakers, breast implants, coronary stents, ear tubes, traumatic fracture repair devices and artificial eye lenses for people with severe cataract problems.

Meanwhile, Obamacare will reduce deductible medical expenses in 2013, requiring people to pay more medical expenses out-of-pocket.

Move up http://i.forbesimg.com tMove downObamacare provides that the Hospital Insurance payroll tax goes up for millions of taxpayers. According to the 2012 Medicare annual report, an estimated 80 percent of taxpayers – which means middle income people — would end up paying higher taxes.

In addition, Obamacare will restrict the use of health savings accounts, forcing people to pay even more medical expenses out-of-pocket.

Moreover, there will be an Obamacare tax on “Cadillac” health care plans. Although this was aimed at “the rich” whom Obama loves to demonize, West Virginia’s Democratic Senator Jay Rockefeller pointed out that it would have hurt plenty of middle class people, too: “virtually every single coal miner is going to have a big, big tax put on them because the tax will be put on the company, and the company will immediately pass it down, lower benefits, and probably this will mean higher premiums for coal miners.” Obama ended up exempting his union buddies — favoritism.

It has been estimated that as many as 16,000 new IRS agents will have to be hired to collect all these Obamacare taxes.