OPINION: Who will care for the newly insured?

Louis J. Goodman is president of The Physicians Foundation, a nonprofit that advances the work of practicing physicians, and Timothy B. Norbeck is its executive director.

Now that the health care bill has passed and the smoke has cleared, for now, from the acrimonious debate, it seems appropriate to reflect on how this significant legislation will affect our health care system. We don't know of anyone who would oppose, on moral grounds, insuring everyone - and that includes us at The Physicians Foundation. But an important issue has been ignored in this debate.

Many groups and think tanks agree that there is a shortage of practicing physicians in the United States, especially those in primary care. Some estimate shortages amounting to 100,000 physicians over the next 10 or 15 years.

At The Physicians Foundation, we worry about the effect this will have on patients and physicians alike. In 2008, in collaboration with Merritt Hawkins & Associates, we undertook a comprehensive survey of all primary care physicians in the country. The results about the difficulties they are encountering in sustaining their medical practices were considerably distressing:

63 percent said that increasing paperwork has caused them to spend less time per patient.

76 percent said they were either at "full capacity" or are "overextended and overwhelmed."

Less than 6 percent of physicians assessed their colleagues' morale as positive and 78 percent reported that over the past five years the practice of medicine has become less satisfying.

Because of these factors, 49 percent of physicians reported that in the next one to three years, they intended to reduce the number of patients they see or to stop seeing patients entirely due to retirement, working part time or by seeking nonmedical jobs.

The entire survey is on our Web site (www.physiciansfoundation.org), and in a new book, "In Their Own Words." In it, physicians detail the growing impediments to the delivery of patient care: the difficulty working with managed care organizations, liability insurance/defensive medicine, nonclinical paperwork, increasing demands on their time, onerous government rules and regulations, and declining reimbursements at a time when their practice costs are escalating.

And now, here come 30 million more insured patients into our health care system. How will there be enough doctors to take care of everyone?

For the past 25 years, the number of physicians completing training in the United States has remained flat, at about 24,000 per year. During that time, a handful of new medical schools have been added, and enrollment is gradually increasing. On Long Island, Hofstra's new medical school is set to open next year.

The Association of American Medical Colleges has initiated a plan to grow medical school enrollment by 30 percent by 2015, but that won't help unless the number of medical residencies available for them, now fixed by law, is increased as well.

Massachusetts, which implemented a similar health care reform to our new national plan in 2006, is now suffering a "critical shortage" of primary care physicians. Not surprising to anyone, however, is that expanded insurance coverage has caused an increase in demand for medical services. But there hasn't been a corresponding increase in the number of doctors to treat the newly insured. Many Massachusetts residents now have insurance coverage but can't find a physician. The Massachusetts Medical Society found in a 2009 survey that 56 percent of Massachusetts physicians in internal medicine are not accepting new patients. And new patients who are fortunate enough to secure an appointment with a primary care doctor have an average waiting time of 44 days.

It is obvious that the United States physician workforce and medical residencies available must be increased - stat - in order for physicians to cope successfully with 30 million new patients. Washington has so far ignored this issue, which will greatly affect patient care and must be addressed now. As noted in Shakespeare's "Henry VI," "Delays have dangerous ends."