What do you get when you cross the state of Massachusetts and the imperative of universal health coverage? A stateside, state-sized Canada. The New York Times explains the mess Massachusetts made when it tried to put theory into practice:
AMHERST, Mass. — Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009.
In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.
Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance.
Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.
Here in western Massachusetts, Dr. Atkinson’s bustling 3,000-patient practice, which was closed to new patients for several years, has taken on 50 newcomers since she hired a part-time nurse practitioner in November. About a third were newly insured, Dr. Atkinson said. Just north of here in Athol, the doctors at North Quabbin Family Physicians are now seeing four to six new patients a day, up from one or two a year ago.
Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months.
“It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”
The U.S. will need 40% more primary care physicians by 2020--and yet the number of medical students opting for family practice is plummeting. And in the coming decade, many existing family doctors will retire. Between high medical school debt and the comparatively low salaries earned by primary care doctors, the situation is not looking good. But it's worth noting that layering onto it a requirement that everyone be insured only makes it worse. Massachusetts primary care physicians were struggling before--but they are in way over their heads now. And the result is that their ability to give timely, preventive care is drastically compromised in ways that strongly resemble Canada and the U.K.