A “Marcus Welby” Shortage?
Wednesday, May 6th, 2009
In 2006, Massachusetts enacted a health care reform bill that requires state residents who don’t get health benefits from their jobs to purchase health insurance. Low-income residents get subsidies to help pay for insurance. Since 2006, more than 400,000 Massachusetts residents have become newly insured.
Unfortunately, Massachusetts has not enjoyed an increase in primary care physicians. According to the Boston Globe, in some parts of the state new patients must wait 50 to 100 days for an appointment. For this reason, emergency rooms are still being overused for non-emergency illness.
According to a report by Liz Kowalczyk of the Boston Globe, nearly half — 47 percent — of problems treated in Massachusetts ERs are not emergencies. This is a notoriously non-cost effective way to deliver health care.
For the most part, Massachusetts has stayed off the “tort reform” bandwagon. It has enacted no limits on non-economic or punitive damages. One of the few “tort reform” arguments that does have some factual validity is that such limits tend to lower physicians’ medical malpractice premiums, which in turn attracts new physicians to set up practices in “tort reform” states. No doubt some conservatives are proposing this very solution as I keyboard.
However, there are some problems with this theory. First, the critical shortage is in primary care physicians, who have much lower malpractice premiums than the high-risk specialties like surgery and obstetrics. And according to Robert Pear in the New York Times (April 26, 2009), “The ratio of primary care doctors to population is higher in Massachusetts than in other states.”
Further, luring doctors from one state to another is no solution to what is actually a national problem. If we ever do get national health care reform, in the short term there could be primary care physician shortages just about everywhere, including “tort reform” states.
A real solution would be to increase the number of primary care physicians nationwide. For many years the number of young doctors going into primary care has dwindled, primarily because there is more money to be made in other specialties. (I should point out that’s in spite of the higher malpractice premiums.) The cost of a medical education is so high — new doctors often graduate with $140,000 or more in student loans — young doctors feel pushed into specializing and going for the bigger bucks.
Solutions for the primary care physician shortage might include higher Medicare payments to primary care physicians and student loan repayment programs for new doctors who agree to go into primary care for some number of years. “Tort reform” might lure surgeons and obstetricians from one state to another, but it won’t solve the essential, national problem of primary care physician shortages.
I cannot emphasize enough that over the next few months we’re going to be hearing many grandiose claims about the benefits of tort reform on the overall health care system. It’s important for us to be clear about which claims are valid and which are not. “Tort reform” limits many kinds of litigation, including the ability of workers harmed by asbestos exposure on the job to seek damages from employers. People should not trade a right to a jury trial for
May 4, 2009
Barbara O’Brien
