Physician shortage in California leads lawmakers to consider new definition of “doctor”

More than three years ago, this website told you about the physician shortage that would be coming and we’re starting to see reaction from states as the problem becomes noticeable. California is suggesting regulation changes to expand responsibilities of nurses, physician assistants and other health care providers when it comes to patient care.

The original physician shortage had nothing to do with Obamacare, but the federal law and mandates are making the problem worse and accelerating the issue. From my November 2009 post.

A couple of lines popped out at me last night while reading Herbert Pardes opinion piece in the Wall Street Journal entitled The Coming Shortage of Doctors. Congress continues to consider a health care plan to fix the crisis that really does not exist. Yes, I know, some people are unable to pay health care insurance premiums and not everything is covered 100 percent, but everyone does currently have access to health care.

My point is that without the service side of the equation – enough doctors – you may not have access to any health care at all.

Even in the absence of health-care reform, according to the American Association of Medical Colleges, the U.S. will face a shortage of at least 125,000 physicians by 2025. We have about 700,000 active physicians today. One factor driving this shortage is that the baby-boomer generation is getting older and will require more care. By 2025 the number of people over 65 will have increased by about 75% of what it is today—to 64 million from 37 million today.

Doctors are also aging. By 2020, as many as one-third of the physicians currently practicing will likely retire. If health-care reform adds millions of people to the health-care market, the shortage of doctors will be even greater than it is projected to be now.

California came up with a proposed solution. Change the definition of a doctor.

[Lawmakers] are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

“We’re going to be mandating that every single person in this state have insurance,” said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. “What good is it if they are going to have a health insurance card but no access to doctors?”

Another down-stream impact the politicians ignored while creating laws to help people.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

This snowball effect will make the physician shortage problem even worse. Smart people have choices. Why would you choose eight to 10 years of higher education to become a primary care physician when the government will soon change the rules so a nurse with four years of higher education can do your job?

Let me point out I’m absolutely certain nurses and physician assistants do have the skill set to mange the care of many patients in many situations – they already do – but do we really want to have fewer doctors as the population ages? Demand is increasing for doctors, and we have laws that require people to see doctors, or encourage them to visit doctors since someone else is paying for it. Since the supply of doctors is decreasing, what possibly could go wrong?

In my opinion we should be encouraging more doctors to become primary care physicians where the shortages are, and will be in the future. Every step the federal government and the state of California is making actually makes the problem even worse.