THE COMING DOCTOR CRUNCH.

lotsofdoctors.jpgThe Obama administration is right to worry about a coming doctor shortage. We have a medical system that's co-evolved with a health care system that leaves 47 million people uninsured and tens of millions more underinsured. It employs about the number of doctors required for that level of care usage. Imagine, however, that health care reform succeeds beyond everyone's wildest dreams and 45 million more people have health insurance by 2012. It's sort of like giving everyone a coupon for a new TV without building any more Best Buys. Unless someone has an idea for quickly growing doctors from stem cells, the system will quickly be overwhelmed.

But it's not just that: One of the themes in Robert Pear's article is the tension between primary care doctors and specialists. It's widely understood that primary care docs are undercompensated. It's also pretty well understood that our system is too heavily oriented towards specialty care, with all its attendant costs and incentives. And it's also pretty well understood that the deficit is looking increasingly impressive. So the idea in some circles is to boost Medicare payments for primary care doctors by cutting money from specialist reimbursement. It's a good idea! It does three things that need to be done: Increases primary care payments, specialty medicine less attractive as compared to primary care, and does it all in a deficit-neutral fashion. But it's not, as you might imagine, a particular popular idea in the specialty community.

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