Monday, April 27, 2009

Doctor Shortage Combined with Pay for Performance

The Obama administration found out about America's doctor shortage, which is particularly acute in primary care. How will covering 50 million uninsured Americans play out in a country with too few family practitioners, internal medicine doctors and obstetrician/gynecologists? Some people will be left out.

Who loses may be driven by Obama's other health care solution, pay for performance. President Obama wants to pay for positive outcomes, for treatments that work. My internist shared his solution. Load up his practice with healthy patients. Healthy patients show healthy outcomes from non-procedure doctor visits. By limiting the number of patients with multiple chronic conditions, my doctor can maximize his take home pay.

U.S. primary care could soon be skewed to healthy patients. It could happen without the transformation of ill patients. Some chronically ill may not have a doctor at all. Guess who will fill America's emergency rooms in such a scenario?

Doctor training has a long lead time, similar to oil & gas discovery. Obama could act right now and the impact will be felt in a decade. Even as President Bush spoke of health care supply and demand, he didn't care about doctor supply.

America's doctor panel is skewed toward retirement age. If physicians get frustrated and retire, the problem grows dramatically worse. President Obama faces a difficult mix of realities in reforming health care.

Doctor supply could be the second biggest constraint. The first is for-profit health care. From insurance companies to big pharma to proprietary hospitals, the for-profit health lobby works to shape the debate and corresponding solutions. Obama tied his hand behind his back with the selection of Nancy-Ann DeParle. She's clearly in the for-profit camp.

Watch reform closely. It could be deform.

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