President Obama: Don't Forget About Doctors


(istock photo)

GUEST BLOGGER: Richard M. Scheffler

With President Obama heading to Capitol Hill this week to lay out his prescription for health care reform before a joint session of Congress, we asked guest blogger Richard M. Scheffler for his perspective. Scheffler is author of "Is There A Doctor In The House? Market Signals and Tomorrow's Supply of Doctors" (Stanford University Press, $27.95), which examines the economics of keeping the health care system sufficiently staffed with properly trained physicians. Scheffler is distinguished professor of health economics and public policy at the University of California, Berkeley.

President Obama's health reform speech next week may be his last chance to get it right.

Providing affordable health insurance for all is the focus of his plan to date, but without systemic improvements to our health care system, we will not get our money's worth or be able to foot the bill. The president must know this and he needs to tell us what he has in mind.

Any reform that covers more people will translate into pressure on the health care system. The system now under-provides basic primary care -- which is key to a well-functioning system. The health workforce needs to be reconfigured. We need more primary care doctors, nurse practitioners and physician assistants, and we need them right away. If we do not have an adequate number of primary care providers, then the reforms will surely fail.

Newly insured patients will not be able to access primary care services, because they will be competing in a market with provider shortages. They may use specialists instead, who are much more expensive and have less experience in many cases in delivering primary care services. Taking care of the whole patient, prevention and safeguarding the overall health of the patient is what it's all about.

So what can the richest nation in the world do about all this?

We can increase the funding for training primary care providers -- not just doctors, but nurses and other health workers as well. Make this part of the reform plan next week. In addition, the president can recognize that primary care providers are underpaid and do something about it. Primary care doctors make about 60 percent of what specialists do.

Most of this is due to low fees. Medicare, for example, has a fee schedule that makes this happen -- it heavily favors specialty care over primary care services. This needs to be changed and the president should tell us how he plans to do it.

Without these changes more will be spent but little will change. We need to pay for quality care, not just more specialty care.

Now is the moment. Leaving out health workforce reforms would be the Achilles heel of any health care reform plan.


By Steven E. Levingston |  September 4, 2009; 11:48 AM ET Health Care , Steven Levingston
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ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECS (2006, 2007, or 2008 figures):

• Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834; $24.3 million in 2008
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771; $9.8 million in 2008
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751; $8.8 million in 2008
• James Carlson, AMERIGROUP, $5.3 million in 2008
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In Las Vegas they call this skimming.

Posted by: angriestdogintheworld | September 4, 2009 2:06 PM

Professor Scheffler has hit the nail on the head. For decades the US has underinvested in the training of all types of health workers. Instead we have relied on importing health workers from poorer counties with their own shortages—severely damaging their health systems. Every year the US imports a minimum of 10,000 foreign trained doctors because it is cheaper to import them than train Americans to be doctors. With or without healthcare reform, more federal, state, and local funding needs to be invested in training young Americans to be healthcare workers. Not only should the focus be on training primary care providers, but we also need to recruit students from medically underserved communities. The limited number of healthcare workers we have are grossly maldistributed in metropolitan and wealthy communities, leaving rural and poor communities with little access to care. Educational loan repayment systems have been shown to incentivize doctors to only temporarily work in underserved communities. Studies of educational programs that recruit and train healthcare students in underserved communities have been shown to graduate qualified professionals who make long term commitments to serving their home communities.

-Dr. Kate Tulenko, Africa Health Workforce Program, World Bank

Posted by: kenheyman | September 4, 2009 2:08 PM

Today was reffered to a specialist by my primary care internist. First call to specialist no. 1. Give us your information, we will call you back after we run a credit check. They called, passed credit check, first availabel appointment Dec. 23, unless theres a cancelation.

First call to next specialist on the list. Sorry the doctor doesn't take medicare people. Me: but I have supllemental insurance, so your paid your fee in full. Respone, yea but your still one of those medicare people. Next three calls on list, them, no new people being accepted. 6th, 7th, and 8th calls: No appointment time available.

It appears thar most Doctors are just greed Basta-rds

Posted by: frluke | September 4, 2009 3:53 PM

I agree with Scheffler. But what's interesting is most of what he recommends is already in the House bill.

-- The House bill would raise Medicare fees for primary care, pediatric care and geriatric care by 5% to 10% (10% if the doctor is working in a region where PC docs are particualrly scarce) plus provide bonsues for primary care docotors who
work collaboratively with other doctors and hospitals, and bonsues for those who do a good job of managing chronic diseaes.

-- The House bill provides greatly increased funding for loan-forgiveness for med students who go into primary care

-- The House bill would increase funding to train nurses and increase pay for faculty who train nurses. (The nursing shortage is caused, to a fair degree, by a lack of teachers. There are more qualified candidates than nursing schools can take because of shortage of faculty . The House bill also creates "nurse-managed clinics."

This is a good op-ed--but I just wish Dr. Scheffler had mentioned that it is all in the House bill. So few people know what is in that bill--or how good it is.

Posted by: mahar1 | September 6, 2009 12:59 PM

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