There are reasons to be skeptical of the widespread predictions of a physician shortage, according to a New York Times op-ed authored by Scott Gottlieb, MD, and Ezekiel Emanuel, MD, PhD.
Dr. Emanuel, an oncologist, is a former health policy adviser to the Obama administration, while Dr. Gottlieb, an internist, was a senior official at CMS during the George W. Bush administration. They say a physician shortage is unlikely to be one of the roadblocks encountered in the healthcare reform law's rollout.
"Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other healthcare workers while incorporating new technologies and practices that make care more efficient," they wrote. "With doctors, as with drugs or surgery, more is not always better."
They point to Massachusetts, where statewide reform was implemented beginning in 2006 and 400,000 people gained insurance coverage. Results of the state's reform suggest shortage fears are exaggerated, according to the authors. Although appointment times for family physicians and specialists "have bounced around" since then, a survey from the Massachusetts Medical Society found they have not appreciably increased overall.
Drs. Emanuel and Gottlieb also say innovations, such as minimally invasive procedures, more effective radiation treatments and remote monitoring, can help pre-empt the need for inpatient treatment. The roles of nurse practitioners, health aides, dieticians and other healthcare providers should expand, they say, noting that policy changes will be necessary.
The authors cite other strategies to curb the much-cited shortage, including updated medical school curriculum focused on team-based care, new payment models to reward investments in technologies, revision of laws that currently inhibit telemedicine across state lines and reformed medical malpractice laws to reduce defensive medicine.
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