The big selling point of the
Affordable Care Act — “Obamacare” to you and I — has been the
extension of health-plan coverage to uninsured Americans. The
implicit promise was that extending coverage would extend actual
care. But yet another study suggests that these new medical
customers, many of whom would be accommodated by expanding
Medicaid, may not be able to find physicians willing to take them
on.

Published October 12 in the American Journal of Medical
Quality, the study with the patience-trying title, “Characteristics
of Primary Care Safety-Net Providers and Their Quality Improvement
Attitudes and Activities: Results of a National Survey of Physician
Professionalism” surveyed “safety-net” physicians, so-called
because they handle the bulk of uninsured and Medicaid patients,
What the authors found is that these health-care providers are
already reaching their limits even before expansion takes
place.

The full text of the report is behind a paid firewall, but a
handy
press release about the study from Massachusetts General
Hospital hits the high points:

The authors note that the concentration of care for Medicaid and
uninsured patients among a limited number of safety-net physicians
and the fact that 28 and 39 percent, respectively, of those
physicians are not accepting new Medicaid and uninsured patients
indicate that the current health care safety net may have reached
its capacity. In addition, they note, safety-net physicians’
interest in quality improvement and attention to health care
disparities suggests that reported differences in the quality of
care they provide probably reflect limited resources available to
their practices or barriers to care within the local
communities.

The authors of the study draw logical inferences for the
expansion of demand for safety-net physicians — and even for
insured patients who may already be running into difficulties
finding doctors as some physicians become
demoralized and even cut back or
leave the field.

“This study raises very serious concerns about the willingness
and ability of primary care providers to cope with the increased
demand for services that will result from the ACA,” says Eric G.
Campbell, PhD, of the Mongan Institute, senior author of the report
to be published in the American Journal of Medical Quality. “Even
with insurance, it appears that many patients may find it
challenging to find a physician to provide them with primary care
services.”

It’s possible that alternative providers, such as nurse
practitioners could help fill in the gap, especially on day-to-day
care. But state-level licensing laws have stood in the way of
exactly that for decades.
Reports Stateline.org:

A 2010 Institute of Medicine report, “The Future of Nursing,”
cited nearly 50 years of academic studies and patient surveys in
concluding that primary care provided by nurse practitioners has
been as safe and effective as care provided by doctors. But efforts
to change “scope of practice” laws to give nurse practitioners more
independence have run into stiff opposition.

Organized physician groups, which hold sway in most
legislatures, are reluctant to cede professional turf to nurses.
Arguing that nurse practitioners lack the necessary level of
medical training, they insist that it is unsafe for patients to be
treated by nurse practitioners without a doctor’s supervision.

So, if you have a medical provider you like, I recommend that
you cling tight and hang on for the ride. The next few years should
be interesting.