Health care overhaul, aging population prompt deficit of 90,000 doctors in U.S.

Washington-area residents are facing longer lines at the doctor's office and hard-to-find health care in the inner city as the U.S. stares down the barrel of a massive doctor shortage.

Thanks to a growing and aging population, and 30 million more Americans gaining health insurance under President Obama's health care overhaul, the U.S. will have a shortage of more than 90,000 physicians in 2020, according to the Association of American Medical Colleges.

Half of those positions will be primary care physicians, doctors who provide check-ups and basic diagnoses. These are usually the first physicians that patients visit when they are sick or injured.

What's up, doc?
Projected U.S. physician shortage
Physician supply Physician demand Physician shortage
2015 735,600 798,500 62,900
2020 759,800 851,300 91,500
2025 785,400 916,000 130,600
Source: Association of American Medical Colleges

"Primary care is the front door," said Jean Hitchcock, a spokeswoman for MedStar Health, which runs 10 hospitals in the Washington-Baltimore area, including Washington Hospital Center, Georgetown University Hospital and Montgomery Medical Center. "We've got 100-plus primary care doctors, but they're scattered around."

The expansion of Medicaid, the federal health insurance program for the poor, under Obama's health care measures

will mean 31,000 new enrollees in D.C., 209,000 in Maryland and 407,000 in Virginia, according to the Kaiser Commission on Medicaid and the Uninsured. That's hundreds of thousands of people who can now seek check-ups and treatment for any afflictions that may have gone ignored previously.

"There is some concern about the capacity of primary care physicians," said Stephen Zuckerman, co-director of the Health Policy Center of the Urban Institute. "In the short run, you're not going to find more doctors."

The federal Patient Protection and Affordable Care Act does not ignore this problem. The law provides for extra funding for primary care doctors who set up shop in low-income areas where many more residents will now be covered.

"Medicaid has traditionally had low payments," said Zuckerman. "The idea is that if you pay a little more for a lot more, you'll get more providers willing to serve the Medicaid population."

Some have pitched a more immediate solution. Nurse practitioners, registered nurses who have undergone advanced training and received accreditation by state licensing boards, are calling for the ability to act as primary care providers independent of physicians.

"We are really well-suited and well-positioned to help with the primary care shortage that exists now," said Beverly Lang, executive director of the Nurse Practitioner Association of Maryland. "By and large, here in Maryland nurse practitioners can function and practice at a high level and high standard of care."

Nurse practitioners in the Free State have the freedom to provide independent primary care and even prescribe medication, provided a consulting physician presents a written statement vouching for them.

Across the Potomac, however, nurse practitioners work under more restrictive regulations. Those in Virginia originally needed physician oversight just to diagnose and treat patients, though legislation passed last year allows them to work in separate locations as part of a physician-led team.

"By sheer numbers, there are more [nurse practitioners] selecting primary care as a specialty than their physician colleagues," said Phyllis Everett, president of the Virginia Council of Nurse Practitioners. "We will need an 'all hands on deck' approach."

Many physicians believe Virginia has the system right. Despite the need for primary care, said Reid Blackwelder, president-elect of the American Academy of Family Physicians, training for nurse practitioners is too variable across state lines to allow them to work independently.

"A family physician, the moment they're done with their training, I know regardless of state or location exactly what their training was: 21,000 hours of training and direct clinical experience," Blackwelder said. "A nurse practitioner varies anywhere from 3,500 to 6,600."