More health coverage doesn’t necessarily mean more doctors

One challenge in extending health care coverage is that there may not be enough primary-care doctors to see new patients, according to Robert Pear in the New York Times. Massachusetts ranks near the top in physicians per capita, but our recent health care reform law is putting a strain on the supply:

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.

“Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.

In the Winter 2009 issue of CommonWealth, Harvard Medical School's Allan Goroll warns of "a vitually empty pipeline of new primary care doctors" (as opposed to specialists) and suggests that changing work conditions are discouraging medical students from entering the primary care field:

We get paid on a volume basis, not on a value basis. We get paid for how many people we see. We don’t get paid for how well the patient does, what value we create in the patient’s life, or the value we create in the health care system. This has created what many doctors call a kind of unsustainable treadmill existence of work, where there are rapid short encounters with many, many patients. There’s often inadequate time to do the job right. Doctors are unhappy. Patients are unhappy. Nobody benefits.