But where are the doctors?

My son and I have had discussions before about the nonsense of providing health care coverage to everyone  without addressing — or even mentioning — the shortage of primary care physicians that already exists in many parts of the country.

Then along comes a New Hampshire doctor, who lives right next door to Massachusetts and its vaunted universal health care, and damned if he didn’t lay it out better than we ever did. Not so surprising, really, since medicine is his business and all.

For quite some time, there have been parts of the country with virtually no health care. Usually they are poor and/or rural areas where the residents must travel many miles to reach the nearest doctor — assuming they can afford the trip in the first place, and then the doctor’s bills on top of that. These are the same people who most likely have no health insurance. It won’t help to give them the insurance without making sure they also have a doctor who will see them and the means to get to that doctor.

Doctors, of course, like to practice where they have patients — patients who can afford to pay for the care they receive. Like the rest of us, doctors have bills to pay, families to feed, etc. It’s not hard to understand why they usually end up practicing in larger population centers where they can make a living.

Have you heard the politicians talking about where they are going to find the doctors and facilities to service all the new patients with their brand spankin’ new medical insurance? No?

Pie in the sky, meet reality.

The medical community has long known there is a disconnect. It has bent over backwards to encourage medical students to become family practitioners and internists. Underserved communities offer scholarships and other types of funding in exchange for the services of newly minted doctors. They hope the doctors will stay in their towns, but the deal is usually only for a few years, after which the doctor very likely moves on to a market with more patients, more labs, more hospitals, etc.

Personally, I think the entire health care reform thing is woefully shortsighted. You can’t go around promising coverage and care to everyone when you don’t have the resources in place to provide that care. Why that isn’t also being addressed is beyond me. But then maybe those savvy Washington politicians know more about it than lil ol’ me, or that doctor in New Hampshire.

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PT also discusses doctor shortages here.