Thursday, December 12, 2019


Right now, roughly 27.5 million Americans are living without health insurance, and it’s caused panic to permeate the entire political spectrum. Democrats are leaping to implement one giant national insurance plan that’ll cover us all, and Republicans insist that repealing Obamacare is the silver bullet. Yet, both sides are focusing on the wrong thing — the way people pay for care. 

Before everyone can receive health care, we’ll have to reduce the very practical burdens on America’s medical workforce.

We don’t talk about it enough, so it’s easy to forget that the United States is running out of physicians. By 2032, there will be a shortage of anywhere between 46,900 and 121,900 doctors — almost half of them in primary care. This terrifying dropoff comes at the expense of one of our biggest blessings: An aging population, which is a wonderful achievement of modern medicine and labor condition improvement. But their medical care involves chronic disease management, a task in which primary care doctors are heavily involved. 

Primary care simply isn’t attractive to most doctors. Less than a third of practicing physicians are in that field, and a growing proportion of medical school graduates are going into a specialty. In fact, in 2015, only 12 percent of them chose primary care residencies.

Why not primary care? Two reasons: Electronic health records and wages.

A new Mayo Clinic study released last month is sounding the alarm on a situation that has gotten out of hand. Physicians are struggling badly with the electronic health records (EHRs) they have to fool with on a near-constant basis. For every hour they spend with patients, physicians spend one to two hours entering data in EHRs. After they get off work each day, they devote another one to two hours. 

And primary care physicians have to do this the most. 

It’s such a terrible setup that doctors are driven either away from the profession altogether or toward setting up direct primary care practices that allow them to focus on their patients instead of paperwork. But those practices don’t take insurance.

It doesn’t have to be this way. Streamlining the regulatory requirements for EHRs would allow more user-friendly EHR vendors into the market, lessening EHR-dread for medical students thinking of becoming general practitioners.

Like any other job, pay comes into play, too. On average, primary care physicians make $237,000 a year, while their specialist counterparts rack up $341,000. There are multiple reasons for this gap, including a difference in how much time they’re required to spend in medical school. Most notably, though, physicians don’t get paid as a function of the time they spend with patients — only for billable activities performed during the visit and a flat fee. As a result, general practitioners won’t get paid as much as specialists, who obviously perform much more complex and expensive procedures. Just like the rest of us, doctors know a bum deal when they see it.

Much more, too, can be done to ensure that all have access to health care services. Jeffrey Flier, former dean of Harvard Medical School, outlined a few options. We could make medical school accreditation easier, allowing more people to pursue a career as a physician. We might simplify the outrageously complicated licensing process for foreign-trained doctors, who have a greater tendency to practice in rural and underserved communities than U.S.-trained ones. We could finally let non-physician professionals, like nurse practitioners and physician assistants, play a more important role in providing care. And we could make telehealth services far more widespread.

To be sure, we need better options when it comes to payment arrangements so that patients can fully profit from the available services. But a low copay on primary care is good for nothing if a working mother wakes up to a sick child and the nearest primary care doctor is two hours away. A foreign-trained physician relocating to the area, a local nurse practitioner with prescribing authority or a mobile app with round-the-clock appointment availability — these solutions will actually be able to give her what she needs.

Health care will be more accessible and affordable to all when we have a freer market thanks to lower barriers to the provision of care, where medical professionals can focus on patients instead of paperwork, and patients have more options to choose from. It’s improvements like these that’ll help more people find the care they need, because merely throwing money at the health care system won’t fix it. Rather, making the work of delivering care more convenient and appealing is likely just what the doctor ordered.

• Elise Amez-Droz (@eliseamezdroz) is a Young Voices contributor and a health care policy associate in the Washington, D.C. metro area. 

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