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Real fear behind the VA scandal

By Jay MacDonald ·
Tuesday, June 17, 2014
Posted: 6 am ET

Amid the scandal over patient care at the nation's veterans hospitals is a larger concern that will have an impact on those with Veterans Affairs health coverage, as well as those with garden-variety health insurance: the looming shortage of primary care physicians. If you think doctors' calendars and offices are crowded now -- well, just wait.
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It's sometimes easy to get lost in the minutiae of the Affordable Care Act and its gradual, long-overdue steering of our health care system away from the expensive fee-for-service model toward one that pays based on health outcomes, not the number of tests performed. Issues like the coming shortage of physicians lack sufficient immediacy and volume to break through the raucous birth cries of health care reform.

But its time is coming, and the coincidental timing of the VA scandal with college graduation season put a spin on it that may just ramp up public concern.

130K more docs needed by 2025

First, the big picture: According to the Association of American Medical Colleges, we're going to need 91,500 new doctors of all kinds by 2020 and 130,600 by 2025. To compound the crisis, Pew Research projects that the population of older Americans will double by 2030, as 10,000 baby boomers turn 65 per day for the next two decades.

So, shrinking supply of primary care doctors plus growing demand for their services should spark a stampede of bright young minds to medical school, right?

Slight problem there. Actually, several. But let's start with the main one: money. Medical school students in this country, on average, carry $170,000 in debt. And with a growing number of primary care physicians having trouble making ends meet in the new health care landscape, a large number of those med students are opting to specialize rather than steer toward lower-paying general practice.

Residencies haven't kept up

"The single biggest deterrent for students going into primary care is their level of debt," says Dr. Charles Lockwood, former dean of Ohio State University College of Medicine who now heads the University of South Florida Morsani College of Medicine.

Those inside the medical training world are watching the doctor shortage unfold in slow motion. Student debt, while very real, is just the start of a tap slowly being turned off.

"There is (also) a serious shortage of residency slots," Lockwood told the Tampa Bay Times. "So even if we were able to increase the number of medical students interested in primary care, if they don't have residency slots, that's a major problem. That's something medical schools haven't done enough to address."

Hospital mergers add complications

As the old fee-for-service system slowly sinks into the sunset, so, too, does the revenue that system once generated that was reinvested into medical research and education. The timing of outcome-based health care puts a further crimp on grants and scholarships.

Hospital consolidation will further complicate the physician shortage.

"People have talked about the future of health care being 10 or 20 national health systems," says Lockwood. "I don't know that I subscribe to that thesis, but I do think scale is going to be critical."

Here's more on the exodus of family doctors to accountable care organizations.

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