The Obama transition team has announced the health care team and has also put a call out to Americans to work on the project as well.
Hopefully, the concerns of physicians like Dr. Chip Roser will be in the mix. Roser is a Boise, Idaho primary care physician, and part of a dying breed.
[I]n a recent national survey, almost half of family practice doctors said they would get out if they could.
That is potentially devastating news for Idaho, which already has fewer doctors per capita than any other state. Specific state-by-state data was not available.
For patients, fewer primary- care doctors like Roser can mean waiting longer to get in to see internists or family doctors, or even trouble finding a doctor who will see them at all.
And the problem of finding available doctors is not confined to rural Idaho.
"The other day, I saw a patient who told me she called around 20 physicians before she found someone who was willing to take a new patient," said Roser, 45, who practices in Boise.
"And it is going to get worse," he added.
A little over a year ago I wrote about the issue for Idaho in particular, and rural America in general in this New West piece.
Yup, Idaho is dead last when it comes to the doctor to patient ratio, around 140 for every 100,000 residents.
It’s actually not much better for the rest of the region. None is in the top half of states when it comes provider access: Nevada comes in at number 48 (not counting D.C.), Wyoming at 47, Utah at 44, Arizona at 37, Montana at 35, New Mexico at 32.
The health care debate in the country and the region has largely been focused around insurance--a valid concern, since some 47 million Americans are uninsured, about 16 percent of the total U.S. population. Those numbers are a little less grim when you look at the Mountain States. In a Democracy Corps poll (pdf) conducted last spring, 10 percent said they were currently uninsured. But when combined with those who had been uninsured sometime in the past five years, the percentage rises to 23.
Of course, having health insurance is small comfort if it takes you four or five or even six months to get an appointment with a regular family doctor.
As part of a comprehensive reform plan, we're going to have to figure out a way to get and keep more doctors in primary care. Insuring the un- and under-insured is absolutely critical, but providing insurance doesn't do you a helluva lot of good for people who don't have any doctor to accept it.
Among the issues that must be addressed are 1) the huge costs of medical education; 2) the significant pay differential between primary and specialty care; and 3) reduction in overhead costs for family practitioners, meaning a reduction in bureaucracy and paperwork. Consider this, from the Statesman story about Roser:
At the University of Washington medical school, which has a special program to take in some Idaho students, 87 percent of graduates are in debt. The median debt was $105,202 in 2006, according to a study published by the university.
Being a specialist helps pay off that debt the fastest. A new primary care doctor initially earns about $130,000 to $150,000 a year, compared with $250,000 to $500,000 a year for newly minted specialists, Patmas said.
Getting the insurance companies to the negotiating table is going to be challenging enough. Getting the AMA and the nation's medical schools to agree to take a hard look at both compensation and at pushing a course of study in primary care is going to another big ol' ball of wax, but one that has to be dealt with to fix this system.
So far this issue hasn't been at the top of the list when the health care crisis is discussed, nor in newly minted HHS nominee Tom Daschle's remarks.
Daschle reaffirmed that reform effort as a major Obama priority, countering speculation that the effort would be put off while the administration gets the country's economy back on track.
Among the principles that will guide that process, Daschle said, will be an effort to increase access to health care for the poor and uninsured; a focus on shifting incentives that undercut preventative care; and the revamping of the country's system of tracking medical information and record keeping.
The good news for underserved communities, though, is that the new administration is already listening. They are calling for input from us--all of us, asking that we hold community meetings over the next few weeks and report back. Anyone interested in hosting a meeting and obtaining a moderator's kit can go onto the transition website (change.gov) and sign up.
Cross-posted at New West.