There are lots of losers in President Obama’s effort to remake the U.S. health care system, and chief among them are the doctors. But there are also winners, especially nurses and physician assistants (PAs). Indeed, nurses and PAs win big in part because doctors lose badly.
Surveys repeatedly show doctors are fed up with low reimbursement rates from Medicare and even lower from Medicaid, which have increasingly led doctors to no longer see new patients in those government-run plans. For example, a recent Texas Medical Association survey found that “34 percent of Texas doctors either limit the number of Medicare patients they accept or don’t accept any new Medicare patients.” Even more do not accept patients with Medicaid.
Then there’s the heavy-handed regulations and requirements from both government and private health insurers. Complying with all those requirements and paperwork creates expensive and time-consuming administrative burdens. And to top it off, there’s the looming shadow of a high-cost lawsuit if things don’t turn out well.
And that’s all before ObamaCare kicks in, which will exacerbate every one of those problems. So it’s little wonder that there are physician shortages, especially in lower-paying primary care, and those shortages are only going to get worse if ObamaCare succeeds in getting an estimated 32 million more Americans insured.
The increased demand for medical care and lower reimbursements—which is one of the primary ways ObamaCare will try to hold down costs—is a recipe for a mass exodus of doctors willing to practice medicine. As “Physicians Practice” reported in August from its physician survey: “Nineteen percent say they plan to move to another position in the same field. An equal amount says they plan to leave medicine—not to retire, but to pursue something new.”
So who will provide the needed care if the doctors exit? Enter the nurses and physician assistants.
If ObamaCare withstands the Supreme Court challenge and Republicans fail to “repeal and replace” it, more nurses will be called on to provide more care that historically has been provided only by physicians—a trend that is already happening.
As the PBS NewsHour reported last May: “The scope of what nurses can do medically has also been growing for the past decade, at a time when the pool of primary care, or family doctors, has been shrinking. … And more and more are working on their own, especially in poor inner-city neighborhoods and rural areas, where there are few doctors in private practice.”
The U.S. Bureau of Labor Statistics (BLS) predicts that the registered nurse (RN) will be the fastest growing profession between 2008 and 2018. And the profession is financially rewarding. The BLS estimates that the average salary for a registered nurse in 2010 was $67,720, or $32.56 an hour. In 2009 the average salary was $63,750, or $30.65 per hour. That’s about a 6 percent increase in a bad economy when millions of Americans were just thankful to have a job.
However, as in all professions, some segments do better than others. A recent survey of 3,000 nurse practitioners conducted by “Advance for NPs and PAs” found full-timers earned $90,770 in 2010. But nurse practitioners in emergency departments earned on average $104,549. Good salaries considering that Medscape reports that nearly half of family physicians, with all their additional training and educational expenses, made between $100,000 and $175,000 in 2010.
Because ObamaCare will never bend the health care cost curve down—as the president repeatedly promised it would—something will have to give. And doctors’ reimbursements will be on the amputation table.
Those payment cuts will surely be politically messy. Just look at the current fight over Medicare reimbursements. Yes, Congress is trying to stop the scheduled 27 percent cut in physician reimbursements—part of a 1997 law that says if Medicare grows faster than a certain rate, physician reimbursements must be cut to balance it out. Because Congress postpones the cut every year, the scheduled cut keeps getting bigger.
That means doctors have received no significant Medicare increase in more than a decade, even though their costs to provide care go up every year. In effect, the Medicare reimbursement problem has resulted in a 20 percent cut in inflation-adjusted dollars. But what is an unacceptable cut for physicians could be an attractive increase for lower-earning nurses and PAs, many of whom are willing to take the lead on providing more comprehensive care.
While it may make sense to expand nurse and PA responsibilities, that decision should be made from the bottom up, in the context of doctors and nurses looking for ways to provide quality patient care at a reasonable cost. It should not be the result of top-down micromanagement and price controls that leave health care providers scrambling to find a way to exist under Washington-imposed regulations. Yet that’s exactly what ObamaCare will do.
Merrill Matthews is a resident scholar at the Institute for Policy Innovation in Dallas, Texas. This post originally appeared at Forbes.