ACP: State of America's health care is poor

Washington, February 2, 2009 -- "The state of America's health care is poor," Jeffrey P. Harris, MD, FACP, president of the American College of Physicians (ACP), reported today at the annual State of the Nation's Health Care briefing. "There are too many uninsured and underinsured people. We have too few primary care physicians." "The problems are big, so the solutions must also be big," Dr. Harris declared. At the briefing, ACP provided recommendations on how President Obama and Congress can take immediate, sustained, and dramatic steps to provide affordable and accessible health care to all Americans and provide every American with access to a primary care physician.

The Institute of Medicine (IOM), a private, non-governmental organization, recently announced that the U.S. needs 16,000 more primary care physicians just to meet the needs of currently underserved areas. The shortage will grow to 40,000 or more physicians, assuming current rates of health insurance coverage, according to two recent studies. At a time when America's aging population is increasing, the demand for general internists and family physicians will continue to grow at a much faster rate than primary care physician supply, in the absence of policies to immediately and substantially increase primary care workforce capacity.

"Giving all Americans an insurance card will not guarantee that everyone will have access to care," Dr. Harris emphasized. "There are not enough primary care physicians to care for them."

To underscore the importance of the timing, Dr. Harris added: "Given the fact that it takes a minimum of seven years to train a primary care physician (medical school and residency combined), the U.S. cannot afford to delay implementation of policies to attract more new physicians to primary care and to sustain those already in practice."

Therefore, policies to expand primary care workforce capacity need to be implemented immediately and go hand-in-hand with coverage expansions. We need to act now to influence the career choices of medical students and physicians already in residency programs, and the retirement and career decisions of primary care physicians already in practice."

The ACP recommendations also call for: - Setting specific goals for increasing primary care, including policies to achieve them and measures to evaluate their success;

- Reforming primary care payment policies to achieve market competitiveness with other specialties, including immediate and sustained increases in Medicare fee-for-service payment;

- Expanding the Patient-Centered Medical Home, and

- Issuing an Executive Order by President Obama to assure that all federal agencies are working together to set primary care workforce goals and the policies necessary to achieve them.

ACP's briefing cited several examples of how patients will suffer if health care reform does not expand the primary care physician workforce capacity at the same time as coverage is expanded:

- For the newly insured, there will be long wait times to get an appointment with a primary care physician, if they are able to find one at all.

- In a growing number of communities, it may become impossible for people who do not currently have a relationship with a primary care physician to find an internist, family physician or pediatrician who is taking new patients. Not because established primary care physicians do not want to accept the newly-insured into their practices, but because they have no time left in an already over-scheduled day to take on any additional patients.

- Patients will have less time with their primary care doctor. Despite insurance coverage, without changes in the way care is provided, physicians may have to further decrease the time they currently spend with patients in order to try to accommodate increased demand for services associated with covering more Americans -- which could have a negative impact on quality, access, and timeliness.

- Massachusetts' experience is a case in point of what can happen if coverage is expanded without expanding the primary care workforce. When health insurance coverage was recently expanded to nearly 95 percent of the state's residents, some low income residents reported difficulty finding a physician or getting an appointment. In fact, the wait to see primary care physicians in Massachusetts has reportedly grown to as long as 100 days.

ACP's recommendations are supported by the 126,000 member organization's new comprehensive evidence review, How is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care? Using more than 100 studies, the paper notes that "even though decades of research tell us that primary care is the best medicine for better health care and lower costs, the current U.S. health care system fails to support policies and payment models to help primary care survive and grow."

A paper published by the ACP in the Annals of Internal Medicine that compared U.S. health care with care in other industrialized countries found that the best performing health care systems abroad, unlike the United States, are built on a strong foundation of primary care.

"A better health care system must result in everyone having health insurance coverage, and everyone having access to a primary care doctor. Anything less than that will fail to provide Americans with access to affordable, comprehensive and personal care they need and deserve," Dr. Harris said in concluding ACP's State of the Nation's Health Care briefing.

Source: American College of Physicians