Dr. David Kim is ready for the next phase of Obamacare. In January he opened a new office of MemorialCare Medical Group in a former Borders bookstore in Long Beach, Calif. He started out with six doctors; now there are 16. The hiring spree is in anticipation of a rush of new patients starting in early 2014, when more pieces of the 2010 health-care law take effect. “We’ve hired so many doctors in such a short period of time, we have the capacity to take on quite a bit,” says Kim, a family practitioner. “The last thing we want is to expand our practice and then have people waiting for appointments.”
Kim’s preparations are a rarity. The U.S. already has a doctor shortage, even as the medical needs of its aging population rise. The problem is about to worsen, with 25 million uninsured Americans expected to get health coverage through the Affordable Care Act by 2016, based on projections from the Congressional Budget Office. About half that number will gain access through changes in eligibility rules for Medicaid, the state-run insurance program for the poor.
No one’s quite sure when the full weight of the newly insured will be felt within the U.S. health-care system, and the troubled launch of the online healthcare.gov marketplace adds to the uncertainty. “There are very few [practices] that are expecting some kind of tidal wave,” says Susan Salka, chief executive officer of AMN Healthcare, a medical staffing and recruiting company. “It will be more of a gradual lift of the tide.”
Massachusetts, which passed a health-care law similar to Obamacare in 2006, may offer a preview of what’s to come. The state has more doctors per capita than any other. Yet patients in Boston have the longest wait times of the 15 U.S. cities surveyed this year by AMN subsidiary Merritt Hawkins, according to a forthcoming report. Physicians were booked for more than six weeks, on average, almost double the next longest wait time, which was in Denver. Roughly half the state’s internists and family doctors aren’t taking new patients, says the Massachusetts Medical Society.
The crunch may begin as soon as January. “We’re now adding a demand shock without being able to add supply at the same time,” says Oliver Kharraz, co-founder of ZocDoc, an online booking system for medical practices. January is already the busiest month of the year on ZocDoc as patients seek appointments when new health policies kick in. This year, bookings through the site on Jan. 2 were more than double the average for the start of other months, with annual physicals topping the list of requested procedures.
By 2025 the U.S. is expected to have 14 percent fewer doctors than it will need to meet demand, a shortage that will be split about equally among general practitioners and specialists, according to the Association of American Medical Colleges. And while nurse practitioners and physician assistants may be able to lighten the load for primary-care doctors, there’s no ready substitute for cardiologists or surgeons. “If you want to see a specialist, you’re going to wait for months,” Salka predicts. “That’s typical in other countries.”