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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Now You Have Health Care Coverage—But Who Will Treat You?

July 3, 2012

Last week’s Supreme Court ruling on the Affordable Care Act was a landmark decision for America’s patients. At the Atlantic Health Care Forum a few months ago, Dr. Timothy G. Ferris, medical director at Massachusetts General Physicians Organization and senior scientist at Partners/MGH Institute for Health Policy, offered a glimpse into the unprecedented change that will take place for doctors and their patients in the next few years.

“It was an historic event when the last one of my patients was no longer uninsured,” Dr. Ferris said about his experience in Massachusetts and the impact of that state’s health care reform law on the patients at his inner-city health center. “The fact that they had insurance was a really big change in how I spent my time. I was more focused on delivering health care and less focused on trying to get around administrating obstacles.”

Medical schools and teaching hospitals see firsthand what it means for patients who aren’t getting the care they need when they need it. While accounting for only 6 percent of all hospitals, major teaching hospitals in this country provide 23 percent of all clinical care and nearly 40 percent of hospital-based charity care. Now that millions more people will have health care coverage, they will get treatment sooner and be less likely to end up in emergency rooms for illnesses that have progressed too far without medical attention.

But with 32 million newly insured people coming into the system, simply having an insurance card won’t mean people will get the care they need. As the AAMC noted in our press statement, this country has a serious doctor shortage—and it got worse when the court handed down its decision. Every day for the next 19 years, 10,000 baby boomers will turn 65. By 2020, the AAMC estimates there will be a shortage of more than 90,000 physicians, from pediatric specialists to primary care providers, from oncologists to cardiologists. 

For Congress, this means the time is now to address this critical need. Medical schools have done their part, increasing enrollment during the last six years in response to shortage projections. But the overall supply of U.S. physicians cannot expand unless Congress increases the number of federally supported residency training positions, a number that has been effectively frozen since 1997. 

Admittedly, the need for more doctors—and more health care professionals overall—only addresses the demographics of our health care system woes. Medical schools and teaching hospitals agree that we need to fix the way our health care system works by making it more efficient, by rewarding value-based care, not volume of care, and developing new payment models such as bundling. We need to do a better job of training new doctors about quality, safety, and working more effectively in teams. We also need to conduct more research about the most effective treatments and make sure this evidence base guides medical decision-making.

Medical schools and teaching hospitals have a long history of pioneering the innovation that improves health. From the polio vaccine to coronary stents for blocked arteries, and more effective treatments for diabetes and cancer, medical schools and teaching hospitals discover tomorrow’s cures and bring them to patients.

Now, we are applying this same innovation commitment to fixing our health care system. Since passage of the ACA, medical schools and teaching hospitals have been in the forefront of changes to transform how health care is delivered in this country.

For example, nearly half of the organizations chosen for the Pioneer Accountable Care Organization (ACO) program are academic medical centers. These health care systems are demonstrating creative and effective approaches to health care delivery and cost containment.  They were chosen through a rigorous selection process to test the effectiveness of innovative payment models and how these models can help organizations provide better care, work in coordination with private payers, and reduce Medicare costs. 

And academic medical centers or institutions, partnering with medical schools and teaching hospitals, make up nearly half of the Center for Medicare and Medicaid Innovation's (CMMI) Health Care Innovation awardees. With projects ranging from the way care transitions are managed to the use of telehealth services and interprofessional teams, the nation’s medical schools and teaching hospitals are improving health care by focusing on solutions to the complex problems of their communities. Beyond simply improving patient care and changing the way doctors practice medicine, these programs also are projected to save an estimated $1.9 billion over three years, create new jobs, and retrain thousands of health care workers with the skills needed to practice in a changing health system.

However, the fact remains: Medical schools and teaching hospitals can innovate, be creative in crafting delivery models, and use all of our valuable experience in education, research, and patient care to devise a better system. But it won’t solve the health care problem in this country if there aren’t enough doctors to treat patients. Congress needs to finish the job by increasing federal support for doctor training. Americans need doctors, not just health insurance cards.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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@AtulGroverMD



For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029
Email: pwillson@aamc.org