Health Policy Experts Anticipate Fewer Doctors, Less Productivity Under Obamacare

Patrick Burke | August 23, 2012 | 6:12am EDT
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Dr. Daniel Shuman is a member of the medical staff at Ashland Health Center, in Ashland, Kan. (AP Photo/Orlin Wagner)

( - Healthcare analysts say that under the Affordable Care Act, physician availability will decrease dramatically, as there won’t be enough practicing medical providers to tend to the greater number of insured patients.

Moreover, once the Affordable Care Act takes full effect -- in 2014 -- some say doctors will have to devote more time and resources to preventive health services, and as a result, productivity will decrease.

Dr. John C. Goodman, president of National Center for Policy Analysis and Research Fellow with the Independent Institute, said as a result of the no-cost preventive services mandated under the Affordable Care Act, doctors will be bogged down with routine medical tests and have less time to spend on seriously ill patients.

“Doctors are going to be spending all their time giving screenings and other tests to healthy people and have very little time left over to treat any real medical problems,” Goodman told

He also believes more doctors will gravitate towards “concierge medicine” to escape the burdens placed on them by the Affordable Care Act.

“Doctors are stepping outside of the insurance system and providing a different kind of service and a better kind of service. So typically, the patient pays $1,500-$2,000 a year, and in return the doctor is usually available the same day or next day. Also they talk to their patients by phone and by email, and they really become agents of the patient in a very bureaucratic healthcare system,” Goodman told

“The Affordable Care Act is going to drive people to the concierge doctors, and those who can’t afford the concierge doctors are going to have long waits for care,” he said.

Christopher Conover, a research scholar at Center for Health Policy & Inequalities Research, also said increasing demand for health services will make doctors less available to patients.

“Obamacare generally substantially increases demand for care,” Conover told, and “it does relatively little to expand supply, so it’s straightforward to observe that shortages will ensue, the only issue being how large these are, how long they will last and how the market will adjust,”

Conover added that the decrease in doctor availability will also boost the number of retail medical clinics in places such as Wal-Mart and CVS Pharmacies.

Another potential issue will be the lack of physician productivity, even if the number of practicing doctors increases, according to Dr. Scott Gottlieb, resident fellow at American Enterprise Institute.

“I think the bigger driver of a shortage of doctors is going to be the fact that Obamacare is going to diminish productivity among physicians. There is ample data that when physicians become salaried or consolidated into employed arrangements, productivity falls. And Obamacare is designed to push doctors into these kinds of arrangements,” Dr. Gottlieb told

“As productivity falls, you'll have doctors simply providing less services in a given unit of time, so even if you increase the number of practicing clinicians, it may not be enough to even offset the lost productivity, let alone accommodate any new demand for services from newly insured patients,” he said.

As previously reported, the Obama administration is well aware of the looming physician shortage.

In June 2010, Health and Human Services Secretary Kathleen Sebelius announced that her department would “invest” $250 million to help “train and develop” 16,000 new primary care professionals, including physicians, physician assistants and nurses, over the next five years.

The $250 million comes from the $500-million Prevention and Public Health Fund created by the Democrats’ Patient Protection and Affordable Care Act (see below).

“These new investments will strengthen our primary care workforce to ensure that more Americans can get the quality care they need to stay healthy,” Sebelius said.

Rep. Lois Capps (D-Calif.), who joined Sebelius for the June 2010 announcement, said the goals of the new health care law can be met only if “we train the next generation of health professionals to provide it.”

The Association of American Medical Colleges estimates that nationwide doctor shortages will grow to more than 90,000 by 2020. Breaking it down, the group says there will be a shortage of 45,000 primary care physicians – and a shortage of 46,000 surgeons and medical specialists – in the next decade.

The shortage is expected to become more acute as the population ages, current physicians retire, and fewer medical students choose to enter primary care before it pays less than medical specialties.

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