More patients, fewer doctors

Did anybody anticipate this? Is this contingency discussed in any of the thousand pages of the healthcare bill? I'm just wondering. When you write a piece of legislation that's almost as long as War and Peace, I'm sure you would like to think you covered every conceivable concatenation of outcomes.

So what's this new phenomenon we're hearing about---"concierge doctors"? It makes me nostalgic for my childhood, actually, conjuring memories of house calls from a distinguished man with a little black bag, and my mom getting the doctor on the phone any time she wanted. I was at the tail end of all that.

But now, in a twist of Providence that---like all twists of Providence---is the confluence of more stray factors than mortal man can wrap his mind around. Hundreds of doctors of the GP variety have bailed out of a system of flat Medicare reimbursements and spiking paperwork demands and have become private physicians to a smaller caseload of patients who are willing to pay cash on the barrel and leave their insurance cards at home.

This comes on top of another trend that could put the president's healthcare dream in the ICU: the increasing number of medical students who are foregoing primary care medicine (the little black bag kind) for the more lucrative and prestigious specialties (the average income of a physician is $173,000; the average income of a cardiologist is $419,000).

These concurring developments are bad timing just when you're trying to add 40 million people (give or take 10 million) to the nation's healthcare system. If these trends continue we will be 40,000 doctors short 10 years from now, according to the American Academy of Family Physicians. The National Association of Community Health Centers says we will need 15,585 more primary care providers if 30 million more patients climb aboard the system.

All of which gives me déjà vu about both the Maginot Line and Germany's attack on Russia. Who would have thought that Nazis would simply sidestep France's impenetrable fortification through the Ardennes Forest? And who would have thought that the winter of 1942-43 would be Russia's coldest in 50 years?

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