Issue link: https://beckershealthcare.uberflip.com/i/462190
29 Clinical Integration & ACOs Many experts don't believe this reasoning substantiates national projections Scott Gottlieb, MD, doesn't believe these factors will lead to a national short- age. A resident fellow at the American Enterprise Institute in Washington, D.C., Dr. Gottlieb co-authored the December 2013 op-ed "No, there won't be a doctor shortage" in the New York Times. "All of the estimates of the doctor shortage are based on straight line assump- tions of today's resource utilization applied to an aging population and more people obtaining coverage, but this presupposes that people who are unin- sured today aren't getting care now and will in the future," Dr. Gottlieb said. "This assumption also presupposes productivity won't increase among phy- sicians and it will. There will also be improvements to technology, so what might be resource-intensive now will be less so in the future." While the high cost of healthcare services certainly deters many uninsured people from seeking care, many of those recently obtaining coverage under the PPACA did receive medical treatment prior to gaining insurance. Accord- ing to the Kaiser Family Foundation, in 2013, nearly 40 percent of uninsured adults had outstanding medical bills. New timesaving technology combined with a growing focus on coordinated care teams, in which nurse practitioners and physician assistants are respon- sible for delivering more care to patients, will improve access to medical care even as patient populations grow. Additionally, the growing emphasis on population health management and patient engagement could help reduce the number of physician visits patients will need. Although the PPACA will not cause a numerical shortage of physicians, Dr. Gottlieb noted it is true that narrow networks of physicians will limit many people's access to care. "There are going to be some people who experience a shortage of physi- cians because they'll be in insurance schemes that limit access to care. People will experience the practical implications of a shortage — not because there aren't enough physicians, but because of insurance," Dr. Gottlieb explained. An inaccurate projected shortage could have serious consequences First, similar predictions have been wrong in the past. According to Dr. Wilensky, co-chair of the Institute of Medicine, previous estimations of looming shortages haven't even been directionally correct sometimes. The country expected a surplus and ended up with a shortage, or vice versa. Furthermore, as discussed later, the number of physicians and degree of ac- cess to them is vastly different across markets. The "nation" isn't on the brink of running out of medical providers, so national projections automatically misrepresent the issue. The credibility of the AAMC and other institutions standing by national projections of a physician shortage is then called into question. According to Kaiser Health News, some health economists believe groups such as the AAMC have self-interest in predicting a shortage because resulting efforts will likely motivate additional funding of the medical schools and hospitals it represents. Dr. Gottlieb shared a similar thought. "I think a lot of these forecasts are be- ing driven by academic medical establishments that would like to see more money going into training medical professionals. I think they really believe in them, but if they're wrong, they are going to undermine their ability to make these predictions in the future," he said. Additionally, investing in efforts to grow the upcoming physician work- force could introduce significantly heavy costs to the healthcare system. Fitzhugh Mullan, MD, the Mudroch Head Professor of Medicine and Health Policy at George Washington University School of Public Health Washington, D.C., and professor of pediatrics at the George Washington University School of Medicine, told Kaiser Health News, training a new physician isn't cheap "for the individual doing the training, isn't cheap for the institution providing the education and ultimately isn't cheap for the health system. Because the more doctors we have, the more activity there will be."