Mandatory Heath Insurance – Are there enough Primary Care Doctors?

A perhaps not entirely unanticipated downside to Massachusetts’s low cost health insurance for all mandate has come to the surface. Even before the mandate went into effect on July 1st, people with medical coverage had trouble getting to see their primary care physicians. Long waits were not uncommon. Now with more residents, theoretically all residents, having health insurance, it is bound to get worse. With more people covered it seems logical to assume that even more people will be making appointments to see the already limited amount of doctors.

For years there has been a growing shortage of primary or family practitioners in Massachusetts and elsewhere. Mainly this has to do with insurance reimbursements. Specialists can expect to make over $225,000.00 annually on national average and primary care physicians only about $160,000. Such a disparity in potential earnings is significant to doctors just coming out of medical school trailing $100,000 to $200,000 in debt behind them. The appeal of a specialist's income is very strong in a state like Massachusetts, where the cost of living exceeds the national average. While income potential may be only one of the reasons, statistics do show a significant drop off in those entering general medicine. In 1998 Internal Medicine or Family Practice was the first choice of 55 % of those going into the field of medicine, in 2005 it had dwindled to only 20%

A task force had been formed in Massachusetts to determine what can be done to pump up those numbers. As the shortage grows, residents cannot wait for health insurance reimbursements to change and tip scales more in favor of primary practice. One idea put forth by the task force is to lessen the workload on Primary Care physicians. For example add more nurse practitioners or physicians assistants into a practice. They can handle more mundane and routine treatments, freeing up the internist to tackle other more interesting and fulfilling duties.


Another idea to get more primary care doctors to handle the volume of the health insurance mandate is to expand upon loan forgiveness programs.  In one such program doctors who agree to work in primary care in challenged areas are compensated for tuition debt left over from medical school. The State and Bank of America have agreed to contribute a total of 10 Million dollars toward a loan forgiveness fund for primary care physicians who will agree to work for two years in community based health centers.

The Massachusetts health insurance reform law has set the state on a bold course to provide affordable health insurance coverage to nearly all its residents. But that accomplishment will amount to naught if there are not enough general practitioners to meet the need. The Governor, insurers and healthcare providers must look to all possibilities, including an even greater loan forgiveness incentive, if that is what is necessary to make sure that health insurance for all really means health care for all.