The Doctor Shortage.

BREAKING NEWS: As of last night, President Obama proposed to increase the number of people in the National Health Service Corps (where doctors' loans are repaid by working in a rural or underserved community) and spend $5.23 billion on primary care training over 10 years. This is a great step forward to address the Doctor Shortage. But what is the this issue? Let's explore!

Critical to the Patient Protection and Affordable Care Act healthcare reform are several changes to our federal-state health insurance program - Medicaid. One of the biggest changes is expansion of eligibility and funding for Medicaid, which, compounded with a growing aging population, will definitely cause a surge of newly insured patients. The problem is - who is going to serve them? This has lead to what many politicians and pundits have called "The Doctor Shortage". Boiled down, it basically means there are not enough physicians to serve the rapidly expanding low income communities. Moreover, not enough physicians want to join primary care or family practice because, after 7-8 long years of training and $250k of debt, it just isn't financially worth it. Is this a problem of the healthcare system or the medical system?

First off, I want to describe a few key items PPACA. I learned most of the information about the health care reform this series of animated videos. They were created by the Kaiser Family Foundation and are really helpful in translating policy jargon to laymen terms.

One of the most important is the "individual mandate" which requires everyone to either be insured by their employer, the government, or to buy private insurance of the marketplace exchange (in California called "Covered California"). More people covered by insurance, more people that need to be seen by primary care doctors. But for doctors, Medicaid is not the most choice insurance program because of the low compensation rate and the time it takes to be paid because of bureaucracy. Wow, what terrible people. Doctor's must just want to get rich... right?

The increase in insured patients under federally and state funded insurance means that most of these people are going to be seen by places that see high concentrations of poverty. This is where Federally Qualified Community Health Centers step in. CHCs are at the forefront of Medicaid expansion. But this is not enough to address the widening disparity in number of people who need care and those who can supply it

Is it really fair to blame doctors for not wanting to take in poor patients? One new physician's experience through the medical system is really poignant:  He writes, "Now, imagine, if you would, having $230,000 dollars in debt with two young children at age 30 and listening to the news with lawmakers saying that doctors are "rich and should have their pay cut. Or that "studies show that doctors lack empathy". If the whole system is unfair - where doctors feel that they are unfairly compensated for the amount of work that they have to do and the patient load is more that they can handle, can we really call doctors the bad guys?