The Massachusetts Canary in the Health Care Coal Mine

The New York Times highlights the strain Massachusetts’ universal health care system is having on the health care system:

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. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance.

Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.

Well, why not just train more doctors?

Whether there is a national shortage of primary care providers is a matter of considerable debate. Some researchers contend the United States has too many doctors, driving overutilization of the system.

Too bad they didn’t specify which researchers, based upon what.

Although the number of physicians per 1000 population has increased significantly in the United States over the past 25 years, the United States ranks 42nd in this measure, right behind Mongolia and just ahead of Kyrgyzstan. Cuba (h/t Michael Moore) leads the world. But it’s not even that simple:

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 decadelong decline gave way this year to a slight increase in numbers, perhaps because demand is driving up salaries.

There have been slight increases in the number of doctors training in internal medicine, which focuses on the nonsurgical treatment of adults. But the share of those residents who then establish a general practice has plummeted, to 24 percent in 2006 from 54 percent in 1998, according to the American College of Physicians.

The Government Accountability Office reported to Congress in February that the per capita supply of primary care physicians actually grew by 12 percent from 1995 to 2005, at more than double the rate for specialists. But the report also revealed deep shifts in the composition of primary care providers.

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.

Massachusetts is considering a law similar to one New York passed this week: forgiving medical school debt for those willing to practice primary care in underserved areas.

It’s a start. The next step would be to get the damned market model out of higher education!

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