A version of this column was published on January 26, 2014 in the New York Times’ Room for Debate blog.
The president should invite someone crucial to the success of the Affordable Care Act: a practicing primary care physician.
Obamacare admirably expands the opportunity to purchase affordable health insurance to the previously uninsured tens of millions, either by expanding Medicaid or through health exchanges like HealthCare.gov. Yet without a strong primary care backbone, those newly insured patients often find themselves without a provider to see. This forces some to seek more expensive care in the emergency department. For instance, after Oregon expanded Medicaid in 2008, emergency visits actually increased, partly because patients weren’t able to see a primary care doctor the same day.
52,000 more primary care physicians are needed by 2025, driven both by expanding health coverage and a rapidly aging population. But only one-third of doctors today practice primary care, substantially lower than other developed countries, and one in five doctors in training choose primary care as a career. It’s no wonder, as medical students graduating with an average debt of $170,000 often choose more lucrative specialty careers. While using more nurse practitioners and physician assistants will help alleviate the shortage, it’s not enough to meet the exploding primary care demand.
Combine the shortage with working conditions that drive more primary care doctors to burnout. More time than ever is spent to fulfill onerous administrative requirements, or transition to cumbersome electronic medical record systems, at the expense of what doctors are trained to do: spend time with patients.
Freeing physicians from such bureaucratic burdens along with addressing the cost of medical education can help stem the primary care shortage. By inviting a primary care doctor to the State of the Union, President Obama can signal that he’s willing to make the necessary commitment to rescue the nation’s crumbling primary care foundation. The success of his signature piece of legislation depends on it.
