I’ve come to the view that the “looming doctor shortage due to ACA” meme is kind of – funny. This article reinforces that view for me:
Doctor Shortage Likely To Worsen With Health Law (Ann Lowrey and Robert Pear, New York Times, 7/29/12)
Why? Because we already have a doctor shortage. We had a doctor shortage, and a declining number of doctors per X number of people in the general population, BEFORE the advent of ACA. (Incidentally, we’re ignoring without inspection the notion expressed by some cranks that significant numbers of physicians will leave the field due to the advent of a statute the chief features of which are an infusion of additional funds into the health care system, and liberalized access to physician services. Some contentions are beneath interrogation.)
We may as well be warning one another of a “payment source availability surplus” – that is, a sudden upward shift in the amount of dough promised to pay for physician visits, even though there aren’t enough physicians for people who will now have access to these promised payments to visit.
Oh wait; maybe that’s what we’re actually doing. Because wouldn’t people who need physician attention now, but don’t seek it because they don’t have a source of payment, go ahead and seek it if they DID have a source of payment handy?
I can here you out there muttering that “that seems like a bunch of confusing nonsense”. Maybe you’re beginning to understand my dissatisfaction with the “doctor shortage” framing.
One point the article makes that I am NOT dissatisfied with:
[Dr. Mark D. Smith, head of the nonprofit California HealthCare Foundation] 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.
What we understand to be care will take different forms than we’re accustomed to. You have a particular level of doctor shortage only if you simultaneously insist (intentionally or not) that care is only care if it is conducted in a specific way; a way that is already in place. Ought we have more physicians, or a different skills/practice mix among the US physicians already practicing? Perhaps. That conversation is quite different from the one the Times reporters seem to be pursuing.
Contrast the “we have a doctor shortage” story line with the thrust of this story, also from the NY Times (this one in the Magazine section):Tweet