Universal health coverage plan in Massachusetts runs into national shortage of primary-care doctors

"In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services, Kevin Sack writes for The New York Times. "Modest pay, medical-school debt, an aging population and the prevalence of chronic disease have each played a role."

Sack's story focuses on rural Western Massachusetts, where the state's new universal health care system -- based on requiring residents to have health insurance -- has created a demand for care that is far exceeding the supply of primary physicians. "About 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage," Sack reports. "Many are now searching for doctors and scheduling appointments for long-deferred care."

The problem affects most states. "With its population aging, the country will need 40 percent more primary care doctors by 2020, according to the American College of Physicians," Sack writes. "Community health centers, bolstered by increases in federal financing during the Bush years, are having particular difficulty finding doctors. ... Studies show that the number of medical school graduates in the United States entering family medicine training programs, or residencies, has dropped by 50 percent since 1997. A decade-long decline gave way this year to a slight increase in numbers, perhaps because demand is driving up salaries."

The Government Accountability Office has recommended changes in a fee-for-service reimbursement system that rewards "expensive procedure-based medicine" and shortchanges primary care, Sack notes. "Numerous studies, in this country and others, have shown that primary care improves health and saves money by encouraging prevention and early diagnosis of chronic conditions." (Read more)