“Tens of hundreds of thousands of Individuals dwell in communities the place they can not discover a physician whereas others have to attend months to be seen.”
Sen. Bernie Sanders (I-Vt.), in a July 19, 2023, press launch
Sen. Bernie Sanders (I-Vt.) has lengthy been a champion of a government-sponsored “Medicare for All” well being program to unravel long-standing issues in the US, the place we pay way more for well being care than folks in different nations however are sometimes sicker and have a shorter common life expectancy.
Nonetheless, he realizes his ardour challenge has little probability in at present’s political setting. “We’re removed from a majority within the Senate. We now have no Republican help … and I’m unsure that I might get half of the Democrats on that invoice,” Sanders mentioned in latest remarks to group well being advocates.
He has switched his focus to incorporate, amongst different issues, increasing the first care workforce.
Sanders launched laws in July that will make investments $100 billion over 5 years to increase group well being facilities and supply coaching for major care docs, nurses, dentists, and different well being professionals.
“Tens of hundreds of thousands of Individuals dwell in communities the place they can not discover a physician whereas others have to attend months to be seen,” he mentioned in a press assertion issued when the invoice was launched. He famous that this state of affairs not solely results in extra human struggling and pointless deaths “however wastes tens of billions a yr” as a result of individuals who “couldn’t entry the first care they want” usually find yourself in emergency rooms and hospitals.
Is that true? Are there actually tens of hundreds of thousands of Individuals who can’t discover a physician? We determined to test it out.
Our first cease was the senator’s workplace to ask for the supply of that assertion. However nobody answered our question.
Major Care, by the Numbers
So we poked round on our personal. For years, educational researchers and coverage specialists have debated and dissected the problems surrounding the potential shortage of major care in the US. “Major care desert” and “major care well being skilled scarcity space” are phrases used to judge the extent of the issue by information — a few of which provides an incomplete impression. Throughout the board, nevertheless, the numbers do counsel that this is a matter for a lot of Individuals.
The Affiliation of American Medical Faculties initiatives a scarcity of as much as 48,000 major care physicians by 2034, relying on variables like retirements and the variety of new physicians getting into the workforce.
How does that translate to folks’s means to seek out a physician? The federal authorities’s Well being Assets and Providers Administration publishes broadly referenced information that compares the variety of major care physicians in an space to its inhabitants. For major care, if the population-to-provider ratio is mostly not less than 3,500 to 1, it’s thought-about a “well being skilled scarcity space.”
Primarily based on that measure, 100 million folks in the US dwell in a geographic space, are a part of a focused inhabitants, or are served by a well being care facility the place there’s a scarcity of major care suppliers. If all of them need docs and can’t discover them, that determine could be properly inside Sanders’ “tens of hundreds of thousands” declare.
The metric is a significant method to measure the influence of major care, specialists mentioned. In these areas, “you see life expectations of as much as a yr lower than in different areas,” mentioned Russ Phillips, a doctor who’s director of Harvard Medical Faculty’s Heart for Major Care. “The variations are critically vital.”
One other means to consider major care shortages is to judge the extent to which individuals report having a typical supply of care, which means a clinic or physician’s workplace the place they might go in the event that they had been sick or wanted well being care recommendation. By that measure, 27% of adults mentioned they don’t have such a location or particular person to depend on, or that they used the emergency room for that objective in 2020, in accordance with a major care rating card revealed by the Milbank Memorial Fund and the Physicians Basis, which publish analysis on well being care suppliers and the well being care system.
The determine was notably decrease in 2010 at almost 24%, mentioned Christopher Koller, president of the Milbank Memorial Fund. “And it’s taking place when insurance coverage is growing, on the time of the Reasonably priced Care Act.”
The U.S. had an grownup inhabitants of roughly 258 million in 2020. Twenty-seven p.c of 258 million reveals that about 70 million adults didn’t have a typical supply of care that yr, a determine properly inside Sanders’ estimate.
Does Everybody Need This Relationship?
Nonetheless, it doesn’t essentially observe that every one these folks need or want a major care supplier, some specialists say.
“Males of their 20s, in the event that they get their weight and blood strain checked and get screened for sexually transmitted infections and behavioral threat elements, they don’t have to see an everyday clinician except issues come up,” mentioned Mark Fendrick, an inner drugs doctor who’s director of the College of Michigan Heart for Worth-Primarily based Insurance coverage Design.
Not everybody agrees that younger males don’t want a typical supply of care. However eradicating males of their 20s from the tally reduces the quantity by about 23 million folks. That leaves 47 million with out a typical supply of care, nonetheless inside Sanders’ broad “tens of hundreds of thousands” declare.
In his feedback, Sanders refers particularly to Individuals being unable to seek out a physician, however many individuals see different sorts of medical professionals for major care, reminiscent of nurse practitioners and doctor assistants.
Seventy p.c of nurse practitioners give attention to major care, for instance, in accordance with the American Affiliation of Nurse Practitioners. To the extent that all these well being professionals take in a few of the demand for major care doctor providers, there might be fewer individuals who can’t discover a major care supplier, and that will put a dent in Sanders’ figures.
Lastly, there’s the query of wait instances. Sanders claims that individuals should wait months earlier than they’ll get an appointment. A survey by doctor staffing firm Merritt Hawkins discovered that it took a mean of 20.6 days to get an appointment for a bodily with a household doctor in 2022. However that determine was 30% decrease than the 29.3-day wait in 2017. Geography could make a giant distinction, nevertheless. In 2022, folks waited a mean of 44 days in Portland, Oregon, in contrast with eight days in Washington, D.C.
Sanders’ declare that there are “tens of hundreds of thousands” of people that dwell in communities the place they’ll’t discover a physician aligns with the revealed information we reviewed. The federal authorities estimates that 100 million folks dwell in areas the place there’s a scarcity of major care suppliers. One other research discovered that some 70 million adults reported they don’t have a typical supply of care or use the emergency division once they want medical care.
On the similar time, a number of elements can have an effect on folks’s major care expertise. Some could not need or have to have a major care doctor; others could also be seen by non-physician major care suppliers.
Lastly, on the query of wait instances, the accessible information doesn’t help Sanders’ declare that individuals should watch for months to be seen by a major care supplier. There was vast variation relying on the place folks lived, nevertheless.
General, Sanders precisely described the problem that tens of hundreds of thousands of individuals doubtless face find a major care physician.
We price it Principally True.
Sen. Bernie Sanders, “NEWS: In Remarks to Advocates, Sanders Proposes Main Enlargement of Group Well being Facilities,” Feb. 8, 2023.
Sen. Bernie Sanders, “NEWS: Chairman Sanders Introduces Main Laws on Major Care and Declares HELP Markup Subsequent Week,” July 19, 2023.
Senate invoice, “To enhance entry to and the standard of major well being care, increase the well being workforce, and for different functions,” accessed July 21, 2023.
Affiliation of American Medical Faculties, “AAMC Report Reinforces Mounting Doctor Scarcity,” June 11, 2021.
Well being Assets and Providers Administration, “What Is Scarcity Designation?” June 2023.
Well being Assets and Providers Administration, “Well being Workforce Scarcity Areas,” accessed July 24, 2023.
Well being Assets and Providers Administration, “Designation of Well being Skilled(s) Scarcity Areas,” accessed July 26, 2023.
KFF, “Major Care Well being Skilled Scarcity Areas (HPSAs),” Sept. 30, 2022.
The Milbank Memorial Fund and the Physicians Basis, “The Well being of US Major Care: A Baseline Scorecard Monitoring Assist for Excessive-High quality Major Care,” Feb. 21, 2023.
The Milbank Memorial Fund, “The Effectiveness of Insurance policies to Enhance Major Care Entry for Underserved Populations: An Evaluation of the Literature,” Jan. 24, 2022.
American Affiliation of Nurse Practitioners, “NP Reality Sheet,” November 2022.
Meritt Hawkins, “Survey of Doctor Appointment Wait Instances and Medicare and Medicaid Acceptance Charges,” 2022.
Interview with Mark Fendrick, doctor and director of the College of Michigan Heart for Worth-Primarily based Insurance coverage Design, July 21, 2023.
Interview with Christopher Koller, president of the Milbank Memorial Fund, July 21, 2023.
Interview with Jacquelyn Resnik, Teladoc Well being, July 21, 2023.
Interview with Russ Phillips, doctor and director of Harvard Medical Faculty Heart for Major Care, July 24, 2023.
Interview with Michael Dill, director of workforce research on the Affiliation of American Medical Faculties, July 24, 2023.
E-mail interview with Martin Kramer, director of communications at Well being Assets and Providers Administration, July 25, 2023.
E-mail interview with Jewel Jordan, public affairs specialist, U.S. Census Bureau, July 26, 2023.
This text was produced by KFF Well being Information, previously referred to as Kaiser Well being Information (KHN), a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.