Wisewon points us to this New York Times article on Massachusetts, which is finding that including more people in your health system requires more doctors. Doctors they don't seem to have. It's all intuitive enough, and should give reformers pause: Give 47 million people access to care, and make it affordable for millions more, and that's going to create quite a backlog for an appointment. Or at least it should. In part, the issue is not so much an absence of doctors as an absence of primary care doctors. Here's a fun fact: Dermatology now has the highest MCAT scores of any specialty in medicine. Why? Good hours and high pay. Increasingly, doctors are going into the specialties either because they're more lucrative or because they offer more control over schedule. This is bad for two reasons: First, it creates a shortage of primary care doctors, who offer important, high value, front line health care. Second, it creates a glut of specialists who want to do expensive interventions. Supply creates demand, and suddenly, you're here. What to do? Well, more doctors, for one thing. And more incentives to go into primary care. Primary care shouldn't pay like a specialty. But it could be attractive because it erases your medical debt (say in return for three years of practicing in an underserved community), you get more control over your hours, and you get to spend real time with patients. I'd also throw more nurse practitioners into the mix, and expand other primary care options, like the Minute Clinics and various other basic care entrepreneurs that are starting to appear in CVS and Target. But, in general, this is the sort of thing that I'm pretty sure the laws of supply-and-demand can take care of, and we may even get some neat innovations along the way.
