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May 10, 2013

Under ACA, doctor supply won’t meet demand

A study published in the journal Health Affairs by University of Chicago Medical Center (UCMC) Associate Professor Elbert Huang forecasts that 29 million people will be insured for the first time in 2014 as a result of the Affordable Care Act (ACA), requiring 7,200 more primary care providers at a time when prospective doctors are being driven into more lucrative specialty areas.

The likely influx of insured patients has medical researchers, practitioners, and leaders in the industry worried that the South Side of Chicago, particularly the neighborhoods of Lawndale and Englewood, will be hit especially hard because of the number of currently uninsured people.

Englewood, for example, is predicted to see a 10 percent increase in demand for primary care, requiring the addition of four doctors to the existing group of 40 practitioners in the neighborhood.

“In absolute numbers it doesn’t seem that bad, but this doesn’t account for the fact that the baseline 40 people already represents a shortage. Also, who’s going to do it? Four doctors who open a clinic? A provider who expands?” Huang said.

Attempting to meet the increasing demand of primary care physicians, the federal government has prepared incentives to accompany the implementation of the ACA, offering a 10 percent hike in salary to primary care doctors choosing to work in medically underserved areas.

But Huang is skeptical of how effective these incentives will be.

“Such incentives are never designed on any empirical data. They are entirely designed on what can be affordable,” Huang said. “Also, we don’t know if these incentives have been noticed by people. I’m quite concerned that it’s not enough. The [salary] gap between specialists and primary care practitioners is much more than 10 percent.”

Non-governmental institutions are taking matters into their own hands. For instance, the Pritzker School of Medicine, the UCMC, and the Urban Health Initiative are encouraging current medical students to choose a career in primary care.

Pritzker Associate Dean of Students James Woodruff, M.D., has noted a trend of student interest in practicing in underserved areas and as primary physicians in the last five years. According to Woodruff, this correlates with the school’s concrete steps to grow and develop mentorship programs, classes, volunteer opportunities, and scholarships emphasizing service learning and working in underserved communities.

For example, a relatively new course introduced less than a decade ago, called Health Care Disparities, focuses on the numerous areas in our country where people have poor access to health care and are given low-quality care.

Similarly, Community Health is one of the possible tracks for the Scholarship and Discovery component of the Pritzker curriculum, requiring every student to complete a project involving community-based research or service learning.

Outside of the classroom, many students volunteer at five free clinics affiliated with Pritzker that provide care to uninsured patients in neighborhoods primarily in the West and South Sides of Chicago.

Service, Education, Reflection, Volunteerism Elective (SERVE) is a fourth-year service learning elective for medical students in which they volunteer at a clinic and then, after clinical training, bring their new skills and help teach newer students. It provides training and support for service-minded students to meaningfully connect with the community.

Repayment for Education to Alumni in Community Health (REACH), a partnership between Pritzker and UChicago’s Urban Health Initiative (UHI), offers a $40,000 yearly stipend to students choosing to work in federally qualified underserved neighborhood hospitals, in addition to their salary, for up to four years.

But Doriane Miller, M.D., Associate Professor of Medicine at the UCMC and Director of the Center for Community Health and Vitality, says limited funding prevents the program from serving more students.

“Since our start in 2009, we have had four scholars to date who are working in primary care settings. I wish we had more funding to encourage more students,” Miller said.

“There is a market opportunity to be a primary care service provider; it’s just that we need people to realize that and take advantage of it,” Jones said, according to the online publication, Medical Express. 

Some question whether it is the responsibility of Pritzker and the UCMC to meet the community’s medical needs, and whether they are sufficiently equipped to in the first place.

According to Woodruff, training students for community-level medical positions is not the ultimate goal of Pritzker.

“Our medical school is focused more on development of physicians that will be leaders in education or clinical care, meaning national leaders or international leaders,” Woodruff said.

Over the past 30 years, five other hospitals in the city have closed, putting additional strain on UCMC in providing for the entire South Side.

“I believe the hospital does have an obligation to serve the community and I do believe it fulfills this obligation on a regular basis, but it will never be a large enough institution to address the needs that presently exist, and once the ACA comes into play, it may further increase this strain,” Woodruff said. “I think this is a societal problem that we can’t really solve on our own.”

—Additional reporting by Maira Khwaja

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