Not enough doctors to go around

Published 8:58 pm Saturday, March 27, 2010

While the dust is still settling after the health care bill passed in Congress, and many specifics are still unknown, health care administrators are beginning to make out the lay of the land.

While there are a multitude of ripple effects the bill will have on citizens and the healthcare industry, a major concern for health care providers is their ability to meet the increased demand.

“We have forever supported increased coverage,” said Sentara Chief Financial Officer Robert Broermann. “All Americans should have insurance coverage. We believe in taking care of people in the most efficient setting at the earliest point in time. But we might’ve preferred the cost curve to be bent, and then to put people into the system. It’s a real dilemma and good and honest debate.”

Broermann explained that through the legislation 30 million people will be put on insurance — 15 million will go on private insurance, and 15 million will go on Medicaid.

“While Medicaid is better than an uninsured patient, doctors lose money on Medicaid patients,” he said. “They get crushed.”

So, while it may be easier to qualify for Medicaid, and people will have the ability to get prescriptions filled, “it will leave a lot of patients scratching their heads, trying to find a doctor,” he said.

“We’re going to see more Medicare patients regardless of legislation, though,” he added. “We live in an aging society.”

Another thing that will help uninsured patients is the fact that hospitals will be required to give them the same discounts offered to insurance companies.

While Sentara already has a program in place to address this, it’s a voluntary program most hospitals do not have, Broermann explained.

“The uninsured patient, by law, is going to be protected against paying list charges,” he said. They’ll be able to access the same discounts insurance companies access through us, even though they’re uninsured.”

One in six people who come into Sentara’s emergency rooms do not have insurance and often come in for a non-emergency need or an ailment that could have been prevented had they seen a physician.

With more individuals able to have insurance, people will go to primary physicians first, freeing up some more room in hospitals.

Again, “it will get them out of the emergency room and into primary care, but it will not produce the doctors and nurses it needs to take care of them,” Broermann said. “They just don’t have the financial capacity to accept the amount of Medicaid patients.”

One solution to get more nurses and doctors into the system to take care of the new flood of patients would be for the government to add “a subsidy to give medical students an incentive to go into private care,” Broermann said. “The base needs to increase in size. The pie is too small and the slice of the pie going to primary care is too small.”

Some are saying the horse came before the cart.

Others — like Congress — have decided to put the people in the system and let the industry figure it out.

“The intent of the bill is to get more people on insured rolls and give them access to the parts of the system they’re currently locked out of,” Broermann said. “The idea is to give more people better care at a lower cost, because there are more people accessing the care. But the problem is with all those people coming into insured roles, do we have providers to take care of them?”