That the Affordable Care Act will open the doors to consistent health care for more people is a good thing, but it will also make a predicted nationwide shortage of doctors even worse unless steps are taken to increase the number of physicians.
Of particular concern is the growing scarcity of family-practice doctors in an era when physicians tend to specialize in fields that help them pay off their medical-school loans quicker.
The imminent doctor shortage reminds some of us older folk of life way back in mid-20th-century America, when there not only seemed to be an adequate supply of physicians but you also could call on one to make house calls even in non-life-threatening situations. That was true even in poor black neighborhoods like mine in Birmingham, Ala.
Growing up in the segregated South was a mixed blessing. It meant at least part of your day was free of racial intimidation and second-class treatment. Quite a few institutions reserved for African-Americans came close to matching the quality of their white counterparts despite the inequity of resources. Medicine is one example of that.
While physicians such as blood-transfusion pioneer Charles Drew were proving themselves at the highest levels of medicine, scores of black doctors — such as Philadelphia’s A.B. Jackson, Henry McKee Minton, Nolan N. Atkinson and James H. Robinson — were successfully treating illnesses, performing surgeries, delivering babies and providing sound medical advice.
I remember the few times my mother called the doctor to come over when our ailments required more than home remedies or over-the-counter medicines. Whatever Dr. Adolphus Plump did always seemed to work, sending my brothers and me back to school before we wanted to go.
How ironic, with segregation long gone and health care now so much more advanced, that poor black families seem to have less access to a physician than mine did back in the 1950s and ’60s.
The physician shortage is expected to get worse as the Affordable Care Act helps insure 32 million more Americans. The law will greatly reduce the 22 percent of blacks and 14 percent of whites without health insurance. The Association of American Medical Colleges says the resulting physician shortage may exceed 100,000 by 2020, with 40,000 primary-care physicians being needed.
A dearth of black doctors is already evident. While African-Americans are 14 percent of the country’s total population, they are only 4 percent of the nation’s physicians. Similarly, Hispanics are 16 percent of the population but only 5 percent of the doctors, according to a study by Kaiser Permanente, which last year gave $1 million to send minorities to medical schools and training programs.
Organizations such as National Medical Fellowships are working with Kaiser Permanente and others to offset budget cuts to the National Health Service Corps, which cut its medical scholarships from 6,159 in 1981 to just 250 scholarships between 2009 and 2011.
Tom Ellison, a medical services director for the U.S. Civilian Medical Volunteer Reserve Corps, is on a personal mission to boost the number of minority physicians by recruiting teenagers into a program that encourages medical careers. Ellison, a cardiologist and epidemiologist, runs Project HELP (Health Education Linkage Program) from the Bruno-Smithfield Community Health Center in Birmingham, not far from Parker High School, where he finds participants.
The students learn how to check blood pressure and blood sugar levels. They wear hospital scrub suits when they go to the health center so residents of the neighborhood can recognize them as participants in a positive program.
“I start recruiting them in the eighth grade,” Ellison said. “In the ninth grade, we get them summer jobs at local hospitals.”
Ellison, 63, who was in the children’s marches led by the Rev. Dr. Martin Luther King Jr., says he is trying to encourage black children the way he was encouraged by black doctors in Birmingham when he was a child. He says 88 percent of the children in his program go into the health field and more than 60 have become doctors.
“We’re trying to reach them while they’re young and show them the value of hard study,” Ellison said. “We want to make it real for them, show them how they can have a medical career that starts them off at $21 an hour or become a technician making $40 an hour.”
If they do want to become physicians, Ellison might help them get a free medical education in Cuba. He works with the State Department to take dozens of students to Cuba, which he visits several times a year.
Ellison says the medical training at the University of Havana is in some respects better than what U.S. medical schools provide, in particular when it comes to becoming a family practitioner. Despite Cuba’s poverty, its infant mortality rate and life expectancy are comparable to those in the United States.
Of course, no individual, not even one as motivated as Ellison, can resolve the looming physician shortage alone. In fact, the AAMC says the number of enrollees in U.S. medical schools reached an all-time high of 19,517 last year, including a 3 percent increase in black medical students and a 6 percent increase in Hispanic students. But it’s not enough.
A major impediment is a cap on federally funded medical residencies that Congress imposed in 1997. Rep. Allyson Y. Schwartz, D-Pa., is co-sponsoring a bill with Rep. Aaron Schock, R-Ill., that would add 15,000 graduate medical education slots over five years, but with Congress more focused on budget cutting than new spending, its fate is uncertain.
Here’s hoping the bipartisan approach Schwartz and Schock are taking prevails. Critics have spent too much time fighting the Affordable Care Act instead of admitting that — like any legislation, even the Constitution — it’s not perfect but can be fixed. With Obamacare adding 32 million to the ranks of the medically insured, it’s time to ensure that there are enough doctors to handle their cases.
Harold Jackson is the editorial page editor of the Philadelphia Inquirer.