A few years ago, several publicly traded HMOs began restricting doctors to an average seven-minute “encounter” with each patient. Seven-minute health care might be cost efficient, but it is a terrible way to practice medicine — and a new study by Northwestern University’s Kellogg School indicates that unless we act quickly, an existing doctor shortage and the Affordable Care Act are about to shorten the time doctors spend with patients even further.
Northwestern’s Kellogg School examined how the State Children’s Health Insurance Program, SCHIP, affected doctor-patient interactions. While more physicians participated in the program, the study found that the average time each doctor spent with each patient was significantly reduced. What’s more troubling, the study concludes that the same can be expected as a result of the Affordable Care Act.
True, doctors are making much more efficient use of the time we do have by allowing other professionals to conduct some of the more routine tests and examinations, where that’s appropriate and allowed under state law. But there’s only so much you can do: seven minutes barely allows time to say hello, much less ask the kind of open, probing questions that enable me, as a diagnostician, to draw you out and make you comfortable to talk about symptoms you might not admit to anyone else.
When politicians of all political stripes promised access to affordable health care, nobody told us they had in mind doctor visits of a duration more appropriate to buying a car insurance policy over the phone. Yet that’s what’s happened, and it’s going to get a lot worse.
As of 2010, the U.S. Department of Health estimated that the U.S. had 15,230 fewer doctors than it needs, yet even in the face of the greatest expansion of health care in generations, Washington has kept in place a 14-year freeze on the number of medical residencies.
The doctor shortage isn’t news; we’ve been aware of it since at least 2006, and the academic community has responded, opening 11 new medical schools since 2007, with 18 more medical schools in the pipeline.
Yet the number of medical residencies, funded by Medicare, has been unchanged since the Balanced Budget Act of 1997.
What’s happening is a bottleneck: too many medical school graduates, too few residencies for them to go to. The Chronicle of Higher Education estimates that within the year, there will be more medical school graduates in Texas than there will be residencies for them to fill. Allow much more time in the waiting room if you live in the Lone Star State.
Washington needs to raise the number of medical residencies to accommodate the increasing numbers of medical students — and it needs to do so quickly. Efforts to include an increase in the number of residencies in the Affordable Care Act, but were lost in last-minute bargaining reminiscent of an Istanbul rug bazaar.
It’s not so frenzied now, and it’s time for Democrats and Republicans alike to put their heads together and lift the cap on medical residencies. It isn’t 1997 anymore; health care needs have increased and the number of patients has greatly expanded.
If we don’t, the medical shortage that’s already evident in much of rural America will worsen, and patients will soon have to wait longer — and travel further — to see their doctors.
And seven minutes will seem like an eternity.
Dr. Mark E. Green, M.D., is an emergency room physician and a Republican member of the Tennessee State Senate representing the 22d Senate District (Clarksville).