Health Care Reform and Physicians Shortage From a Hospitalist Perspective

A recent BusinessWeek article "Physician, Cloneis very costly. On a national level it adds up to the
Thyself" suggests an alarming physician shortagebillions of dollars.
in the future due to an increasing access toThe problem, though, goes beyond insurance
medical care. The author speculates that once 30issues. Some patients, even with a good
some million additional patients become insured,insurance, are simply not being compliant with
that will put a tremendous stress on a primarytheir treatment. They can afford. They just don't
care system. There is already a shortage of thecare enough about it to make any changes. And if
primary care physicians and even more patientsthings get worse? Well, then they just be
'eligible' to see a doctor will, surely, make it worse.readmitted to the Hospital since somebody else is
Lets look at it from a hospital based physicianpaying for it anyway.
perspective.As far as shortage of the primary care providers,
Many patients with chronic conditions like Diabetesthe problem will likely to get worse. The issue,
or Hypertension simply do not have any adequatethough, is not the increasing number of the 'eligible'
outpatient follow-up. Thus, these patients usepatients. If anything this is a welcome change. This
Emergency Rooms and Hospitals as their careis the whole point of the healthcare reform - to
providers which add tremendously to the cost ofmake everybody insured. The real problem is how
care. Many patients 'have to wait' until theirunattractive the specialty became for the medical
condition is bad enough so that they could go tostudents and residents. When I was finishing
the Emergency Room and be admitted.medical residency, the general attitude was - you
Managing chronic conditions on an outpatient basishave to try to get into fellowship or become a
might reduce readmission rate and, actually, cuthospitalist. And if you can't, well... than you go to
the cost of the healthcare. By preventingprimary care. Oh, and if you are a foreign medical
complications of many chronic diseases likegraduate on a J-Visa, you might get stuck doing
Diabetes, patients could avoid costly treatmentsprimary care to get a visa waiver.
and procedures in the future. For example, beingWe can open a lot more Medical School spots, but
compliant with your insulin will decrease the risk ofuntil Primary Care becomes more attractive for
kidney failure, coronary artery disease, stroke etc.the new graduates, nothing is going to change.
Once those complications develop, treating them