Supplying The Demand For Primary Care Doctors

As law makers debate health care overhaul, they are also considering ways to increase the number of primary care doctors across the country. If the plan passes, it will cover 30 million additional Americans and some fear there aren't enough doctors to meet the anticipated need. Host Liane Hansen talks to Dr. Atul Grover, the chief advocacy officer for the Association of American Medical Colleges.

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LIANE HANSEN, host:

As health care overhaul legislation advances through the Senate, lawmakers are debating a number of proposals and amendments, including an effort to increase the number of primary care physicians across the country. If the health care bill is approved, more than 30 million Americans would be covered, and some fear there aren't enough family doctors to meet the anticipated need.

Dr. Atul Grover is the chief advocacy officer for the Association of American Medical Colleges. And he's in the studio. Welcome to the program.

Dr. ATUL GROVER (Chief Advocacy Officer, Association of American Medical Colleges): Thank you for having me.

HANSEN: Democratic Senator Chuck Schumer of New York reportedly plans to introduce an amendment to the health care bill that would add funding for 2,000 medical residency spots in order to get more primary care physicians into the pipeline. Will that be effective?

Dr. GROVER: I think it's a good start. The problem is that we're facing, even without significant expansion in insurance coverage, a shortage of somewhere between 125 and 150 thousand physicians by the year 2025. And why that's important now is because you can't just pull doctors off the shelf. We're talking about on average 10 years to train and educate them. So it's something we need to think about now.

HANSEN: Well, why are some senators opposed to the idea of more of these slots?

Dr. GROVER: Well, I think a lot of it comes down to money. And we know that they've had a tough time keeping the total budget for the health care reform package under the limit set by the president of $900 billion. Now, from that standpoint, when we're talking about an additional 15,000 slots - which is what we'd really like to see come out of legislation - that'd be about an extra billion dollars a year, or 10 or $12 billion over 10 years. That's a big amount of money.

But if you think about it in the context of what Medicare spends every year -somewhere close to half a trillion dollars on medical care - it doesn't seem like a lot to spend to insure that there are actually physicians out there, to care for medical beneficiaries and the rest of the American public.

HANSEN: So what will happen if an additional 30 million Americans get added to the health care rolls, if they're already now are too few primary care doctors?

Dr. GROVER: Well, I think it's going to be tough for everybody, but particularly for people who are already underserved. And those are people who are living in rural areas or people who are already financially underserved, don't have insurance. We're going to get to a lot of them, but not all of them.

And it's important to note that we're not just going to have a shortage of primary care physicians. About a third of those docs that we're going to be shorter on primary care, but the other two-thirds are going to be across the range of specialties because, essentially, anybody that cares for the elderly is going to be in short supply. We're talking about, really, doubling the number of people over 65 in the next 15 years or so. And that's going to be just a really unprecedented amount of demand for medical care.

HANSEN: I'm speaking with Atul Grover, chief advocacy officer for the Association of American Medical Colleges. Suppose these spots open up for new medical students, how do you maintain the quality of medical care? You're opening up a lot more slots. And there's an old joke, you know, if you graduate last in your class and become a doctor, what are you called? And you're still called a doctor.

Dr. GROVER: Right.

HANSEN: How do you maintain quality?

Dr. GROVER: There are a lot more qualified people who are applying to medical school right now, than there are actually spaces for. And that's why our members have committed to expanding by 30 percent over the next two decades to make sure that we have enough physicians to take care of a U.S. population. But without an increase in residency training programs, that really completes their training, we're not going to have enough physicians.

So we believe that there's a very, very strong applicant pool out there right now. And our data would indicate that even if we expanded by 30 percent, we would not see any decline in the quality of physicians being produced.

HANSEN: Why is it that you think more medical students are choosing to go into specialty fields of medicine, as opposed to primary care? For example, cosmetic surgeons?

Dr. GROVER: I think, you know, it's probably a pretty complicated issue when you think about anybody and their specialty choice or their professional careers and how they make those decisions. There are certainly financial issues, particularly when medical students are looking at - by the end of training now - an average of 150, $160,000 in loans.

So if you have two physicians getting married, they're essentially are starting out with a pretty big mortgage without even having a house. I would say that because of the vast disparities in reimbursement and the smaller degree of hassle for cosmetic procedures, you will certainly see that, whether it's primary care physicians doing botox injections or plastic surgeons doing more elective cosmetic procedures, than reconstructive, there certainly is a push in that direction because of the reimbursement incentives.

HANSEN: Dr. Atul Grover is the chief advocacy officer for the Association of American Medical Colleges. Thanks for coming in.

Dr. GROVER: Thank you.

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