Now that health care reform has been passed and enacted (no longer a bill, but a law), health care will become available for millions who have lacked access until now.
The next big question, then, is where will these patients go? American Medical News published an article indicating that by 2025 the nation will lack nearly 160,000 physicians that will be necessary to provide care for the nation. 46,000 of this anticipated 160,000 physician shortfall are primary care physicians--the very core of a cost-effective and patient-centered health care system. This issue has already developed in Massachusetts, where state law has extended health care coverage to essentially all of the state's residents. The article notes that 40% of family physicians and 60% of internists in the state have stopped accepting new patients, and the wait for a new-patient appointment with a primary care physician is up to 44 days.
Passing health care reform is a tremendous accomplishment. However, it is necessary to take the next steps to truly reap the benefits. At the heart of the efforts is the need to increase the numbers of medical students choosing primary care careers.
There are innumerable reasons medical students choose specialties other than primary care; probably as many reasons as there are medical students. Lifestyle, income, prestige, etc--all of these play a role. There has been a trend in medical students choosing the better-paid and better-lifestyle ROAD specialties (Radiology, Orthopedics, Anesthesia, Dermatology), while primary care specialties have struggled to attract high quality applicants.
There are many steps to addressing this issue. We need to make primary care more appealing to students, which will require addressing the costs of medical education, the payment structure of a health care system where procedural specialties are paid better than "intellectual" specialties, looking at concerns of physician burnout, etc.
Passing health care reform was a critical step. Now, we have to turn our sights to the next steps to make the promises real.