The American Interest
Analysis by Walter Russell Mead & Staff
Obamacare’s Achilles Heel: Primary Care Physicians

Millions of Americans will get new health coverage under Obamacare, which means that millions of new patients will need doctors—specifically, primary care providers. According to the Washington Post, Obamacare will require almost 30,000 new primary care physicians by 2015.

Unfortunately, primary care is the road less traveled through medical school, less lucrative and prestigious than the alternatives. Young doctors who specialize can expect to earn $3.5 million more over a lifetime than their peers in primary care. While there are promising signs that some medical students are turning down that road despite more profitable alternatives, they number just a few.

It’s not just new doctors who have an economic incentive to eschew primary care. Specialists are more lucrative for hospitals too: “A radiologist will earn a hospital $193 in Medicare reimbursements every hour, a primary-care doctor brings in $101.”

It seems to us that this was a foreseeable hurdle for healthcare legislation. More patients require more doctors, obviously. It makes one wonder what other failures are baked in the cake of this hastily written, poorly reviewed bill that Congress passed without reading, much less reflecting on.

Published on February 13, 2012 4:30 pm
  • Eurydice

    Not just a “foreseeable” hurdle, but a “foreseen” hurdle. At the time of the ACA’s hasty writing and poor review, people warned about this, people predicted this, and they pointed to the reality of the experience of health care reform here in Massachusetts. The answer was, “we’ll figure it out when it becomes a problem.”

  • stephen b

    It won’t be long until “specialists” opt for government jobs instead of careers in medicine. That’s where money will be in Obamacare future, not medicine.

  • Thomas F. Mulrooney, MD

    This is an overstated problem, based on the assumption that preventive services and minor health problems require that patiens be seen by physicians. Nonsense. Advanced practice nurses can readily handle the needed encounters, just as hospital corpsmen have been doing in the Navy (and similar personnel in other branches of the military) for many years.
    Mr. Meade has elsewhere argued for simplifying and rationalizing legal work, so that the need for lawyers can be controlled. THe same process can be applied to medicine and to everyone’s satisfaction. Physicians would be far happier to take care of the seriously ill and devolve triage work to well trained nurses or others on their team.

  • Jim.

    Simply passing a law expanding the seats for medical schools, and expanding residency programs, would have done far more good than passing that monstrosity that is ObamaCare.

    We need that repealed… which means we need a president whose name is neither Obama, nor Romney.

  • Jacksonian Libertarian

    Obamacare is Big Government on steroids, destroying what little feedback from competition still remains in the health care industry. We can expect Quality, Service, and Price to all get much worse. I expect queues with wait times measured in months and years, for getting a primary care physician, surgery, doctor visits, etc… Contrast that with the Quality, Service, and Price for Lasik, or Cosmetic surgery which must be paid for from the patient’s own pocket.
    If the only Health insurance available was High deductible ($2,000) with tax free Health Savings Accounts, the feedback of competition would return to the Health Care industry, and improvements in longevity and quality of life would accelerate.

  • thepi

    The fact that specialists made more money than general practitioners was a clear price signal by the market that we needed more specialists.

    Unfortunately, government managed to freeze medical prices in amber. Originally, specialists making more money was an incentive to bring balance to the system, but now that everything has been frozen in place the price signals will create greater and greater perverse incentives until something breaks.

  • Soviet of Washington

    Jacksonian…that’s why Dr.Rich (covertrationingblog.com) has stated multiple times:

    “DrRich has pointed out many times that the real battle we will face as Obamacare is being rolled out is the battle over whether American citizens will retain individual freedom sufficient to be permitted to spend their own money on their own healthcare. Indeed, DrRich has written a series of posts that spells all this out in painful detail. If you need to know why limiting individual prerogatives is so critically important to Progressives, and why Obamacare must be the vehicle for establishing these limitations, simply read the first post in that series.”

  • Eurydice

    @Thomas #3 – As I’ve experienced the situation here in Massachusetts – it’s not about who administers the actual care, it’s that one needs a primary care physician in order to have access to care. When my PCP closed her practice and moved out of state, it took me two years of being on waiting lists to find another one. And it actually happened in a backwards manner – I needed specialized and major surgery and the surgeon bumped me up the waiting list because I had to have a PCP on record.

  • Walter Sobchak

    My nephew graduated from a top rank medical school last summer. He told me that only five of his 100 classmates were going into general medicine internships.

  • Corlyss

    As long as doctors and nurses remain free people, they will not be able to cover the entirety that Obamacare contemplates. Which means that you will start to see proposals to educate doctors in return for 10 or more years of fealty to the federal goverment. But since that will take time to produce enough doctors, the federal government will have to conscript them and dictate where they will practice. It’s unavoidable.

  • Chris

    I agree with Dr. Mulrooney. We just have to be smarter and more realistic about how we deliver care. I have served in army special operations for 20 years and SF trained enlisted medics (physician assisstant equivalents) have taken care of me for the most basic of health issues without a hitch. They can help you through the standard stuff and are smart enough to know when to pass you to an MD for a more specialized care, if required. We just need the legal and regulatory reform to be able to do this AND acceptance of this from the broader medical community. Just think, a large robust, professional middle class of workers who would only need 2 very intense years (vice 8+) of specialized training taking care of the basics in medical care, delivered at a fraction of todays costs. Couple that with modern technology and access to volumes of medical data and it starts to drive down costs while still providing excellent care.