What does the Affordable Care Act — aka Obamacare — mean to you? Is it a long-overdue promise of universal health care? Is it moving America in the wrong direction — towards socialism? Has it become mainly a political tool being played up by both Republicans and Democrats to sway voters?
A lot of political debate has gone into making a universal health care bill for the United States, and unless things change quickly the debates will continue raging for several years to come. But we need to take a step back and look at the human element of health care in the United States. There are a lot of aging Americans who will need additional health care in the near future, and the United States is hurtling towards a doctor shortage of large proportions.
When the entirety of Obamacare is enacted, an additional 32 million Americans will be covered by health insurance. Meanwhile, as the baby boomer generation grows older, the number of elderly Americans will increase drastically over the next 10 years: the Census Bureau predicts a 36 percent increase in those 65 and older over the next decade. Combined, these forces will see the demand for qualified doctors, both general physicians and specialists, rise dramatically over the next decade.
As the number of seniors grows and the demand for doctors increases, the workforce of doctors is aging as well. According to the American Association of Medical Colleges (AAMC), about one third of doctors who are practicing today will retire in the next decade.
An analysis of predicted supply and demand for full-time physicians conducted by AAMC shows that over the next decade the country could be facing a shortage of 45,000 primary care doctors, as well as a shortage of 46,000 surgeons and specialists. Among the most underrepresented doctors in the near future will be general surgeons, ophthalmologists and orthopedic surgeons. By 2025, there may be as many as 130,000 too few doctors to meet public demand.
These shortages will be felt by everyone, as doctor’s appointments become harder to get and waiting rooms grow more crowded. However, the effects will be most acutely felt by vulnerable populations in inner-city and rural areas. These areas already have trouble attracting doctors, who are preferentially choosing to take jobs in moneyed suburbs or wealthy urban areas. This means that even with a universal health care program in place, there will remain an inaccessibility problem for those who can’t afford to live in the kind of neighborhoods that attract an adequate supply of family doctors, let alone specialists whose numbers are either stagnant or shrinking under the current system.
One would expect the shortage to be answered by an increasing number of students choosing to enter medicine, looking forward to a steady job and good pay in a medical career. In fact, there are plenty of students seeking MDs, and the number of medical schools and the number of graduates they produce has been steadily increasing.
Most sources agree that the cause of the doctor shortage lies in the number of residency programs available in the country. Residency programs provide valuable training to medical school graduates, but the cost of training one resident for a hospital has grown to be huge: $145,000 per year according to one article on bloomberg.com. At these costs, hospitals are reliant on the federal government in order to support their residency programs. This funding is provided by Medicare, which pays the hospital directly for each resident they take in. The amount of money allocated for this purpose has been frozen since 1997 when Congress placed a cap on how much could be spent on residency programs, making it very difficult for hospitals to expand their residency programs as the baby boomers grow older and the doctor shortage looms. This cap has kept the number of resident positions available in the United States at about 110,000 for the past 15 years. The federal government’s stagnated funding for specialists has at times been even more stagnant. Since 1970, the number of dermatology residents has been highly consistent, around 300 per year.
Hopes for an increase in funding for medical residencies seem slim in today’s political climate. President Obama offered some incentives to those entering the medical field in the Obamacare bill he signed into law, but did not alter Congress’s cap. Presidential candidate Mitt Romney, meanwhile, has suggested a major overhaul of Medicare. His campaign has criticized Obama’s cuts to Medicare that provided a large portion of the money that will fund Obamacare. Romney has vowed to restore funding to Medicare, although it is unclear where this money would go. Most of Obama’s cuts eliminated overpayments to health insurance companies, and putting those overpayments back into the legislation would be a step backwards in American health care.
In order to meet a rapidly growing demand for doctors, Congress and whichever presidential candidate wins the 2012 election must act quickly to either increase government funding for residency positions or fundamentally change the system of training doctors in the United States. Medical schools have done all they can do, but their enrollments must be capped with an eye to the difficulties their graduates face trying to find residency programs.
A solution will not be cheap: a recently introduced piece of legislation proposed additional funding of nine billion dollars to add just 3,000 residencies per year for the next five years.
But no matter the cost, the federal government must act. If they don’t, the American public health system will be overwhelmed, and the ramifications will be wide-reaching. In this country, universal health care will never be a reality until we have a workforce of doctors who can truly serve the needs of all Americans.
