Ed Balls: Pressure grows for Plan B as triple dip threatens
Noted for January 28, 2013

Ann Marie Marciarille: Riddle: How Many Doctors Will It Take to Implement One Affordable Care Act?

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Missouri State of Mind: Riddle: How Many Doctors Will It Take to Implement One Affordable Care Act?:

If you saw the recent Wall Street Journal article on the development of Smartphone apps to detect skin cancer, you may already be wondering about specialty physician over-supply…. [T]he fourth app… the one with the astonishingly accurate results that used a system that forwarded data and images to board-certified dermatologists for remote review at a cost of $5 per mole -- you could tell Christopher Weaver at the Wall Street Journal was intrigued. I am as well. Teledermatology is not particularly well developed in the United States but is fairly advanced in Australia…. [D]ermatological care for some Australians is provided, in part, remotely.

There are many other health care related apps out there but not as many as you might think…. (If you have one in mind, here's a forum for you to seek fame and fortune: http://rwjf.org/en/about-rwjf/newsroom/newsroom-content/2012/12/foundation-announces--200-000-developer-challenge.html?cid=Xtw_qualequal. No worries if you miss today's deadline, this is an ongoing series of competitions.)… [I]t is not difficult to imagine a trend line on dermatology: fewer dermatologists practicing remotely in ever larger specialized practice settings… we can already notice [this] in some parts of radiology… the specialization of the visual exam reader may also improve accuracy -- both in screening function and in elimination of expensive-in-every-way (financially, clinically, emotionally) false positives. I think of this as the paradox of learning to have clinical confidence in the doctor you never meet: the super specialized mammogram reader, for example, you hope you never meet.

Even if this raises interesting questions about specialty physician supply, what about the primary care physician shortage?… [T]he example above contemplates additional responsibilities for primary care providers coordinating with remote dermatologists. I recently had the privilege of teaching in a UMKC Business School program for physicians--medical directors in particular…. This group was genuinely concerned about finding the providers…. They have everything to be afraid of in a medical educational system where fewer than 20 percent of medical students end up working in primary care…. If we re-invented primary care to be oriented toward a team approach with each team member rewarded for serving to the limits of their licensed authority and training, we might not need a huge infusion of primary care physicians. We might need a huge infusion of advance practice nurses or health educators or any number of associated health professionals…. Rushika Fernandpulle has written in Health Affairs about "The Big Shortage" along these lines. And, like him, I wonder  do we even have a physician shortage at all?

Riddle: How many doctors will it take to implement one Affordable Care Act?

Answer: Fewer than you might think.

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