Poor patients could face difficulty finding a doctor once the Affordable Care Act is fully implemented, according to a new survey.
Nearly 28 percent of primary care physicians responding to a nationwide survey say they will not accept certain patients, despite a deluge of people -- anywhere from 30 million to 50 million -- expected to gain coverage under the health care law.
The majority of new patients are expected to seek care over the next two years.
"We did a representative sample of primary care physicians around the country and asked whether they were currently accepting Medicaid or uninsured patients," said medical policy expert Eric Campbell of Massachusetts General Hospital in Boston.
Campbell, who also teaches at Harvard Medical School, said he and his colleagues framed their questions with an emphasis on the words "Medicaid" and "uninsured" because those terms are markers -- code -- for poor patients.
Even though half the 840 doctors answering the survey said they would be willing to accept new Medicaid patients or currently uninsured patients, doctors who identified themselves as "safety-net" physicians were more likely to accept patients from both groups.
Safety net doctors are those who routinely treat low-income patients, Campbell said.
In the survey, 72 percent of doctors who identified themselves as safety net physicians said they would consider taking on new Medicaid patients; 61 percent said they would take uninsured patients.
Safety net doctors, Campbell said, tend to be paid less and are often graduates of foreign medical schools.
Even with safety net doctors accepting new low-income patients, Campbell said his findings raise concerns about the overall willingness of primary care providers to face what may soon be an explosive demand for services.
The survey is published in the current issue of the American Journal of Medical Quality.
"We are not saying the Affordable Care Act is a bad idea," added Campbell. "That's not the intention of this study. This research was done to document the safety net and inform the medical community about the challenges going forward."
On Long Island, Nassau University Medical Center, the region's largest safety-net hospital, not only will be accepting new patients but is developing new models of health care delivery to accommodate low-income patients, said chief medical officer Dr. Steven Walerstein.
For the past few years, Walerstein said, he and other NUMC executives have anticipated an escalating number of patients as a result of the health care law. They assessed the increase, he said, in line with NUMC's primary mission.
"We are a public hospital," Walerstein said. "Our future direction is primary care and to decrease hospitalizations while delivering a higher level of care at a lower cost."
NUMC, Walerstein noted, has created a new family medicine residency program as part of its primary-care focus. The new doctors will help bolster the ranks of primary-care physicians.
Additionally, Walerstein added, NUMC is instituting so-called "medical homes," a type of home base where patients can receive routine care. The aim is to keep patients out of emergency rooms.
"Many people come to the emergency department for something that isn't an emergency," Walerstein said. The hope, he added, is to move people away from episodic treatment and into the habit of preventive care: colonoscopies, mammograms and other screenings.