AAMC president Darrell Kirch on the impact of a physician shortage

Last year on July 3, I wrote about a vision of health care delivery about “the "patient-centered medical home."

The "home" is the office of a primary care doctor where patients would go for most of their medical needs. This medical home may sound like the gatekeeper model of the 1990s, a managed-care creation that was all about holding down costs. But advocates say the new concept is designed to help patients, not insurers. It's more like doctoring 1950s-style, but now juiced up with digital technology.

Click here to read “The family doctor: a remedy for healthcare costs?”

But of course the challenge of making this vision real is a shortage of doctors.

Darrell G. Kirch, president of the Association of American Medical Colleges, recently wrote that the physician shortage is, in part, a result of expectations in the 1990s that managed care and primary care would greatly drive down the need for physicians, particularly specialists. However, these expectations fell short against the rising needs of an aging, growing population that has high expectations of its health-care system.

Kirch says today, the overall number of physicians in the U.S. is lower than the average per capita number of doctors in other nations such as Sweden, Denmark, Spain and France, and we now "import" some 25% of our physicians from other countries. While expansions of U.S. medical schools can close this part of the gap, the overall per capita supply of doctors in the country will decline without an expansion in the number of residency training positions. This expansion will not occur unless Medicare resumes paying for its share of training costs.

Because it takes so long to train a new physician, Kirch says, Congress must lift the freeze on support for medical training now, as part of health-care reform. While the cost to add new physicians is significant, it is less than 1% of current Medicare expenditures and an essential investment if people are to have timely access to a physician's care, not just the promise of insurance coverage.

Even those who expect the U.S. health-care system to be transformed in the next decade know that wishful thinking cannot provide the care they and their families will need. Congress is right to expand insurance to as many Americans as possible. But it also has a responsibility to ensure that the nation is cared for by more than an insurance card and an answering machine.