Too many patients, too few doctors?

With the passage of health care reform, there might not be enough primary-care doctors to handle an increase in patients.

According to 2008 Kaiser Family Foundation’s statistics, 6,507 — about 40 percent — of Ind.’s nonfederal physicians practiced primary care.

Now that health care reform is law, why are there so few primary-care doctors?

“It’s economics,” said Dr. Aaron Carroll, Pediatrics professor at IU’s School of Medicine, explaining that specialists make more money than primary-care physicians.

This is partly because of health care’s fee-for-service payment system, he said.

In order to pay for their education, medical students have more incentive to go into a specialized field rather than primary care, Carroll said.

About 60 percent of doctors in the U.S. practice specialty care, he said.

“That’s way too high considering the fact we need everybody to go into primary care,” he said.

Phil Morphew, CEO of the Indiana Primary Health Care Association, already sees a shortage of primary-care employees.

The IPCHA includes 47 community health centers that serve more than 500,000 patients, about 10 percent of Indiana’s population, Morphew said.

“Our patient load is growing at a rapid rate, and health reform is going to expand it much further,” Morphew said, adding that IPCHA will serve more than one million Hoosiers by the end of the next five years.

There aren’t enough providers to meet the expected increased demand, he said.

Along with a shortage of primary-care physicians comes concerns with Medicaid, a government program that provides health care for adults with low-income and children, as well as the disabled.

In 2014, everyone whose income doesn’t exceed 133 percent of the federal poverty line will qualify for Medicaid.

Neil Pickett, director of Health Policy Research and Analysis for Clarian Health, said there’s a concern that although more people will have insurance through Medicaid expansion, they might not be able to easily find a primary-care physician who will accept their insurance.

Some physicians won’t accept Medicaid patients or will limit the number they accept because the program doesn’t pay enough to cover the full cost of medical care, he said.

Dr. Carroll said he thinks Medicaid reimbursement is less of an issue.

“A lot of patients who will be getting Medicaid under health care reform were previously uninsured,” Carroll said. “So while you might not be getting reimbursed at private insurance rates, getting reimbursed something is better than getting reimbursed nothing.”

To address the influx of Medicaid patients in 2014, the federal government will increase Medicaid payment rates to those of Medicare, a government program that provides health care for the elderly, from 2014 until 2016.

Morphew said the government’s temporary increase of Medicaid reimbursement rates isn’t as much of an issue for community health centers as it is for private practices.

Currently, the centers provide additional enabling services, such as a staff that’s fluent in Spanish, in exchange for receiving higher Medicaid reimbursement rates than private practices, he said.

“We are two different animals,” he said. “We are able to handle the Medicaid load, but for a primary-care physician, it’s much more difficult to do that when they’re already receiving a rate of payment that is below their expected rate.”