One City Built to Last

y amy m. armstrong
Physician Shortfall
in the
Affordable Care Act
A Problem of Supply and Demand
As courts continue to hammer
out whether the subsidies
promised to low-income
holders of health
insurance benefits via the Affordable
Care Act are legal and will be honored,
the looming question of just how all of
these new medical stakeholders will
be serviced has yet to be answered.
America is one year into these
ground-breaking changes in health
care, with a second round of enrollments
kicking off Nov. 15, 2014 and
scheduled to last three months. This
first year’s enrollment and successful
payment of premiums by approximately
7.3 million Americans was announced
in August. It was significantly
lower than the 12 million enrollees/
payees that the Obama Administration
hoped for a year ago. Yet, based
on the roll-out glitches with online
health care exchanges, administration
officials characterized August’s
announcement as a positive step forward.
As of now, the American medical
system has 7.3 million more people
eligible for basic health services.
If they have not found one already,
they are currently seeking primary
THE SUIT MAGAZINE - NOV 2014
health care providers. This means that
7.3 million more cases of the flu, the
common cold, high blood pressure or
things more complicated such as cancer,
heart conditions and stroke may
be coming through the doors of clinics
and hospitals.
All are eligible for basic services.
But are there enough providers to go
around? And will the shortfall even
create additional cases for the legal
system as the newly insurance-entitled
add litigation to the experience
when their medical expectations have
not been met?
Just ask the leaders in the medical
and legal industries, and they will vehemently
tell you there is a big problem
looming on the horizon.
“With the implementation of the
ACA, the biggest challenge is that,
while in principal we are providing
greater access to all Americans,
the number of health care providers
qualified to provide this care is disproportionate
to the number of people
eligible,” said Suzanne Arragg, a
certified legal nurse consultant and
owner of SEA & Associates in Ventura,
California. Her firm evaluates the
merit of medical cases from the perspective
of the nursing staff, who interact
with patients significantly more
often than doctors. “To make matters
even worse,” she said, “The number of
qualified providers is also disproportionate
to the reimbursement offered
under ACA for the care and services
provider.”
Arragg forecasts a landslide of legal
actions as patients get fed up with lack
of access or with the treatment errors
that are bound to occur in an overwhelmed
system.
She is not alone.
Last fall, the Association of American
Medical Colleges warned that the
nation’s inventory of qualified doctors
had dropped nearly 20,000 from the
previous year. More than half of the
doctors still practicing are older than
50 and headed toward retirement, according
to the AAMC. Looking ahead,
the AAMC indicated a shortfall of
45,000 primary care doctors by 2020
unless a major increase in enrollment,
graduation and successful completion
of internships occurs. That was
a conservative estimate – and did not
include an expected deficit of 46,000
medical professionals who handle
specialties.