Health Care Reform and a Doctor Shortage

A Shortage of Doctors

Now that Congress has passed a health-care reform bill of some kind and it is signed into law, we could see, about 30 million uninsured people who will suddenly find themselves access to doctors. The health-care overhaul is certain to add to the problem by flooding doctors’ offices with new insured consumers looking for healing. One only has to do the math and see that when giving millions of people insurance, you will find a shortage of doctors.

Not Training Enough Doctors

Congress placed a limit in 1997 on the number of medical residencies in order to hold down Medicare costs. Medical residencies are hospital training that is required for all doctors. The number is limited because Medicare pays for most of that training. However, even without health-care reform our nation is experiencing a doctor shortfall because of an aging population and their demand for medical specialists.

Medicare Isn't Big Enough

Funding for residencies through Medicare was setup in 1965 when the U.S. Government was about to extend health coverage to about 19 million Americans. Unfortunately, Medicare has grown to 45 million last year and the cap was placed to control spending. Currently Medicare pays about $100,000 a year per residency, at a total cost of about $9 billion. The Medicare cap affects about 90,000 residencies at U.S. hospitals.

Doctor Demand Outgrowing Supply

Medical schools have tried to accommodate by adding 3,000 first time students by 2018, but the cap on residency has not been lifted. Without that cap lifted, the demand will continue to out pace the supply. According to the U.S. Health and Human Services Department, there are nearly 17,000 fewer primary care doctors than what was required for most urban and rural areas. By the year 2025 many experts expect that number to rise by as many as 160,000.

The Cap Needs Reform

Many within Congress are trying to get amendments submitted to the health-care bill to increase the residency cap. Adding about 15,000 residencies to that cap would cost Medicare currently about $1.5 billion. However, hope is thin on the amendment passing as Congress is wrestling on keeping the total cost of the health-care reform bill down.

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Ralph Deeds 6 years ago

Another view.

Health Cuts With Little Effect on Care


Published: December 29, 2009


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Jay Paul for The New York Times

Peter Bernard wants to expand Bon Secours, the health care system he leads, in Virginia.


Times Topics: Health Care Reform

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At the heart of the health care debate is the question of whether it’s possible to cut medical costs without harming patients. What has happened here in Richmond helps to answer that question.

Since 1996, the Richmond area has lost more than 600 of its hospital beds, mostly because of state regulations on capacity. Several hospitals have closed, and others have shrunk. In 1996, the region had 4.8 hospital beds for every 1,000 residents. Today, it has about three. Hospital care has been, in a word, rationed.

Neither the House health reform bill nor the Senate version would impose any such reductions on the nation’s hospitals. But the basic idea behind the bills’ cost-control measures is similar. They would try to slow the growth of medical treatments, be it through new rules for Medicare, a Cadillac tax on the costliest insurance plans or other measures.

So take a glimpse at what our future may look like:

The quality of care in Richmond is better than in most American metropolitan areas, according to various measures, and it continues to improve. Medicare data, for example, shows that Richmond hospitals do a better-than-average job of treating heart attacks, heart failure and pneumonia.

When I recently asked patients in Richmond whether they felt as if their care had been rationed, they found the question bizarre. “I feel like there’s nothing cheap about the care,” Janet Binns, a retired school district employee, said. After her elderly father fell down one morning, she e-mailed a doctor and was on the phone with him in minutes.

Yet when it comes to health care costs, Richmond’s rationing has made a clear difference. In 1992, it spent somewhat less than average, per capita, on Medicare — 126th lowest out of 305 metropolitan areas nationwide. Since then, though, costs have risen at a significantly slower pace than they have elsewhere. As a result, Richmond had the 39th lowest costs in 2006.

tpcooke profile image

tpcooke 5 years ago

Very good points, MB2456.

I live in Massachusetts and they enacted a similar health care bill in this state several years ago. It is my understanding that the model created by Massachusetts was used to determine aspects of the new Federal Health care reform bill.

Having recently moved here from Virginia, my husband and I have found it very difficult to obtain doctors appointments as everyone is required to have insurance. Therefore there is not enough time in the day, week, year, to get everyone in to see a doctor. Forget it if you have a serious cold and need to see a doctor quickly.

Glad to hear that others are focusing on the need to produce doctors from the medical schools who specialize in the care of our seniors. Our senior population is growing rapidly and there exists a large need for doctors that can care for these individuals. Everyone that I know that has told me that they are going into the nursing or health care field and are undecided as to which direction to go into, I always say "have you thought about geriatric medicine."

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