Courtesy of Knowledge@Wharton

While the possibility that millions of uninsured Americans might soon have access to health coverage may conjure images of patients stacked up in hospital hallways or waiting for months for an MRI, the most likely stress point in an expanded health care system will involve the family doctor.

The supply of primary care physicians is already tight in some parts of the country, and finding a general practice doctor will probably become even harder if the pool of insured Americans expands.

“The biggest chokepoint in the health care system will be the availability of primary care doctors,” says Wharton health care management professor Mark V. Pauly. “The physician bodies just aren’t there.”

He and other Wharton School health care experts say that existing infrastructure – hospitals beds and technology, for instance – will likely be able to accommodate any influx of patients, but expanding the physician workforce to meet added demand will take both time and a concerted effort. “If they are going to use health care reform to emphasize preventive medicine, it’s not clear that they have thought through whether there is adequate capacity in primary care,” notes Kevin Volpp, a Wharton professor of medicine and health care management, and director of the Leonard Davis Institute of Health Economics’ Center for Health Incentives. “That’s a bigger issue than hospital beds.”

The American Association of Medical Colleges (AAMC) projects that even if the number of physicians remained the same, there would be a shortage of 124,000 doctors of all types by 2025, although the number could climb to as high as 159,000 should demand for doctors pick up along with wider insurance coverage.

Experts are particularly worried about a dearth of doctors to focus on primary care services, including routine checkups and sick visits. There are already primary care physician shortages in some rural areas, as well as in more populated communities. Merritt Hawkins & Associates, a physician recruiting and placement firm, reported in June that from April 2008 to March 2009, it had more requests for family doctors than for any other type of doctor. Requests for primary care doctors were up 23% compared to a year earlier.

“Virtually every hospital or large medical group in the United States would be happy to add a family physician or general internist. There simply are not enough primary care doctors to go around,” Merritt Hawkins president Mark Smith wrote in a statement accompanying the firm’s report.

The AAMC wants to increase the number of slots at U.S. medical schools by 30%, both through the expansion of existing classes and the creation of new medical schools, but it takes time to educate and train doctors – four years of medical school and three or more years of residency, perhaps followed by a fellowship. “Even if we could magically expand medical schools in the next year, it would be years before we have more doctors,” Pauly says. And even if more students are enrolled in medical school, it won’t be easy to reverse a steady trend away from primary care practice in favor of specialty fields.

The various health reform scenarios being debated on Capitol Hill place some emphasis on bolstering primary and preventive care. The idea – a familiar theme heard especially in the early days of HMOs – is that if everyone had a so-called “medical home” with a primary care physician, they would be more likely to get timely and preventive care, thus avoiding more costly trips to specialists and emergency rooms. Uninsured Americans don’t necessarily go without surgery or care when they get sick – but they may put off treatment or be seen by a doctor in the emergency room instead of the doctor’s office.