The U.S. House of Representatives’ passage on Saturday of a health-reform bill that could extend health-insurance coverage to 96 percent of Americans has added new urgency to efforts to train more primary-care physicians, speakers told thousands of medical-school administrators and educators here on Monday.
“If you expand coverage without expanding primary care, you will overwhelm emergency rooms that are already overcrowded,” said Tom Daschle, a former U.S. senator from South Dakota who is now a senior fellow at the Center for American Progress, a Washington think tank. Mr. Daschle had been President Obama’s pick for secretary of health and human services before he withdrew amid a controversy over taxes he had failed to pay.
Health reform is the hot topic at this week’s annual meeting of the Association of American Medical Colleges, which drew an estimated 3,700 attendees.
If health-care legislation makes it through the Senate and a compromise version is signed into law, millions more people could be eligible for insurance coverage. However, if the experience in Massachusetts, where a smaller-scale health-care overhaul was approved in 2006, is any indication, there won’t be enough doctors to go around, warned Herbert Pardes, president and chief executive of New York-Presbyterian Hospital, a teaching hospital for the medical schools of Columbia and Cornell Universities.
“If we’re going to tool up and treat more people, we need more doctors,” he said. That would require lifting a cap on the number of residency positions that Medicare will pay for—a costly move lawmakers have been unwilling to make.
Several teaching hospitals in Massachusetts are struggling financially, partly because they are receiving less money from the federal government on the assumption that they would be treating fewer uninsured patients.
A Supply Problem
Meanwhile, a nationwide shortage of primary-care doctors is expected to worsen as baby boomers retire.
Debt is one obstacle. The average medical-school graduate today starts out owing about $156,000 in loans, according to the medical colleges’ association. “It is utterly absurd that our graduates have that kind of debt,” said Arthur S. Levine, dean of the University of Pittsburgh School of Medicine. “Every day, students tell me they’d like to be primary-care doctors, but they can’t afford to.”
Primary-care doctors not only earn significantly less than those in other specialties, but they are reimbursed by Medicare at much lower rates.
Attendees urged the medical colleges’ association to continue lobbying for loan-forgiveness plans and more-generous reimbursement policies for family doctors.
Mr. Daschle also said the United States relies too heavily on international medical graduates to fill primary-care slots.
“I don’t feel good about going to other countries and taking their best and brightest and offering them the opportunity to serve here,” he said.
Despite the challenges of caring for millions more people, most medical educators here were excited about the prospect of vastly expanded health-insurance coverage and the opportunity to transform the American health-care system.
Part of the problem with the system, Mr. Daschle argued, is that too much money is spent on costly interventions like heart transplants and too little is spent on preventive care.
“Every other society starts at the base of the pyramid and works their way up to the top until the money runs out,” he said. “In the United States, we start at the top of the pyramid and work our way down, and the money does run out.”
Many academic medical centers, which are known for providing costly, specialized care, are trying to bolster the bottom of the pyramid by educating children in their communities about healthy living and steering adults to neighborhood clinics and health fairs, participants noted.
Another way academic medical centers can help improve the delivery of health care is by participating in a system of “health-care innovation zones,” Darrell G. Kirch, president of the association, told attendees on Sunday.
The association has been working with Congress on recently introduced legislation (HR 3664), which it hopes to see wrapped into an overall health-care bill, that would encourage academic health centers to experiment with other hospitals and health-care providers to help specific patient populations.
“Just as we have a moral imperative to give people basic health insurance, we have an innovation imperative—as educators, researchers, clinicians—to finally make our health-care system work well for everyone,” he said.
