Welcome To The Waiting Room

There are not enough primary care physicians to meet the demand for care among the existing insured population. Adding 46 million patients without addressing the shortage of care options will overwhelm an already strained healthcare system.

As the health care debate heats up, lawmakers are devoting their attention toward “extending coverage.”  While reducing the number of uninsured Americans is certainly a laudable goal, making this the first goal of healthcare reform is to put the horse in front of the carriage.  There are not enough primary care physicians to meet the demand for care among the existing insured population.  Adding 46 million patients without addressing the shortage of care options will overwhelm an already strained healthcare system.  Expanding coverage without expanding care will make an already inefficient health care system much, much worse. Merritt Hawkins and Associates recently published the results of the “2009 Survey of Physician Appointment Wait Times” which it conducted to determine the average time that new patients must wait before they can see a physician in a variety of large metropolitan areas.  The study found that average wait times had increased by an average of more than a week since the last time they conducted the same survey in 2004.  As the study notes, “The survey is intended to gauge patient access to medical services and may be taken by healthcare professionals as one indicator of the current state of physician supply and demand in select markets and in select medical specialties.”  The vast increase in average wait times is a clear indication that there are simply not enough physicians to meet the demand for care that currently exists. How bad is it?  On average, wait times have increased by 8.6 days per city. Boston had the longest wait, averaging 49.6 days, followed by Philadelphia with 27 and Los Angeles with 24.2. Residents of Washington looking for care could expect to wait an average of 22.6 days.  In the survey’s conclusion, the authors make no bones about what the survey’s results tell us:

Despite having a high number of physicians per capita, many of these markets are experiencing appointment wait times of 14 days or longer. The survey was conducted during a historic economic recession when physician utilization and hospital admissions are reported to be down. An economic recovery may be expected to increase physician utilization and extend appointment wait times. Boston, a city in a state that recently expanded access to healthcare coverage, shows the longest average times to schedule an appointment. These long wait times serve as a sign of what could occur nationally if access to healthcare is made more generally available through healthcare reform.

Although “Romney Care” (the 2006 health reform initiative that mandates that nearly every Massachusetts resident have health insurance) has not reigned in costs, none other than Massachusetts Senator Teddy Kennedy recently introduced legislation that copies the “Romney Care” measure of requiring Americans to own health insurance. Adding 46 million people to the existing coverage pool without significantly increasing the amount of care available is nothing short of insanity.  Dr. Richard Cooper, a Professor of Medicine at Penn, pointed out to USA Today that the government is restricting education spending which restricts the supply of doctors yet the government is ambitiously moving to expand insurance coverage and access.  In other words, the government is suppressing supply while aggressively fueling demand.  As Cooper told USA Today, "This [expanding coverage] will demand more physicians. It's like preparing for a war having previously decided to stop training soldiers. Madness.” If President Obama and Democratic lawmakers go forward with their plans to create universal coverage without first addressing the already stretched supply of primary care physicians, we can expect to see wait times skyrocket nationwide just as they did in Boston.  If that happens, we are going to find out the hard way that individuals are not going to be willing to wait 50 days; instead, they will go to the emergency room... and when this starts happening, well if you think health care costs are out of control now, you ain’t seen nothin’ yet.  To have coverage without care is to have no care at all.