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Doctor Shortage Likely to Worsen With Health Law

RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

加州里弗賽德——在南加州飽受經濟危機創傷的“內陸帝國”(Inland Empire)地區,奧巴馬總統的醫療法案預期將在2014年為逾30萬人帶來醫療保險。但保險覆蓋率并不是醫療服務:當地衛生專家認為,該地區的醫生數量將很難滿足需求。而且,這種短缺已經存在。

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

美國其他地區,包括密西西比三角洲、底特律以及鳳凰城郊區,都面臨同樣的問題。美國醫學院協會(The Association of American Medical Colleges)預計,2015年全國將出現6.29萬名醫生的短缺。到2025年,隨著保險范圍擴大以及嬰兒潮人群老齡化引發醫療護理需求的增長,這個數字將增加一倍。即使沒有醫療法案,2025年醫生的短缺數量仍將超過10萬人。

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.


“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

“除了整形和皮膚科醫生外,我們各種醫生都缺,”加利福尼亞大學里弗賽德分校醫學院院長G.·理查德·奧爾茲(G. Richard Olds)稱。這所新醫學院的成立在一定程度上就是為了解決該地區醫生資源匱乏的問題。“10年內,無論怎樣努力,我們都將有著5000名醫生的缺口。”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.


“It results in delayed care and higher levels of acuity,” said Dustin Corcoran, the chief executive of the California Medical Association, which represents 35,000 physicians. People “access the health care system through the emergency department, rather than establishing a relationship with a primary care physician who might keep them from getting sicker.”

“這引發了治療延后以及病情惡化,”加州醫學會(California Medical Association)的負責人達斯廷·科科倫(Dustin Corcoran)稱,該醫學會有3.5萬名醫生成員。人們“進入醫療系統要通過急診部,而不是靠和給他們提供日常醫療保健的初級保健醫生建立關系,而這些醫生本可能防止病人的病情進一步惡化。”

In the Inland Empire, encompassing the counties of Riverside and San Bernardino, the shortage of doctors is already severe. The population of Riverside County swelled 42 percent in the 2000s, gaining more than 644,000 people. It has continued to grow despite the collapse of one of the country’s biggest property bubbles and a jobless rate of 11.8 percent in the Riverside-San Bernardino-Ontario metro area.


But the growth in the number of physicians has lagged, in no small part because the area has trouble attracting doctors, who might make more money and prefer living in nearby Orange County or Los Angeles.


A government council has recommended that a given region have 60 to 80 primary care doctors per 100,000 residents, and 85 to 105 specialists. The Inland Empire has about 40 primary care doctors and 70 specialists per 100,000 residents — the worst shortage in California, in both cases.


Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one-third of the overall growth in coverage in President Obama’s health care law.


Providers say they are bracing for the surge of the newly insured into an already strained system.


Across the country, a factor increasing demand, along with expansion of coverage in the law and simple population growth, is the aging of the baby boom generation. Medicare officials predict that enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.


“Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

“美國老年人對醫療服務的需求量遠超從前,”美國醫學院協會會長達雷爾·G.·基爾希(Darrell G. Kirch)稱。“老年人更可能患有有多種慢性疾病,需要更深入、協調的治療。”

The pool of doctors has not kept pace, and will not, health experts said. Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement.


Physician compensation is also an issue. The proportion of medical students choosing to enter primary care has declined in the past 15 years, as average earnings for primary care doctors and specialists, like orthopedic surgeons and radiologists, have diverged. A study by the Medical Group Management Association found that in 2010, primary care doctors made about $200,000 a year. Specialists often made twice as much.

醫生的工資也是一個問題。過去15年中,醫學院學生選擇從事初級保健醫療的數量已經減少,因為初級保健醫生和骨科醫生、放射科醫生等??漆t生相比,他們之間的工資差距在拉大。醫療集團管理學會(Medical Group Management Association )的一項研究發現,在2010年,初級保健醫生的年薪約為20萬美元,而??漆t生的年薪一般都在這個數字的兩倍左右。

The Obama administration has sought to ease the shortage. The health care law increases Medicaid’s primary care payment rates in 2013 and 2014. It also includes money to train new primary care doctors, reward them for working in underserved communities and strengthen community health centers.


But the provisions within the law are expected to increase the number of primary care doctors by perhaps 3,000 in the coming decade. Communities around the country need about 45,000.


Many health experts in California said that while they welcomed the expansion of coverage, they expected that the state simply would not be ready for the new demand. “It’s going to be necessary to use the resources that we have smarter” in light of the doctor shortages, said Dr. Mark D. Smith, who heads the California HealthCare Foundation, a nonprofit group.

加州的很多衛生專家稱,他們雖然歡迎擴大醫療保險覆蓋范圍,但預計該州還沒有準備好去滿足這些新的需求。因為醫生的短缺,我們“應該更加明智地利用現有資源,”非營利性組織加州醫療基金會(California Health CareFoundation)的負責人馬克·D·史密斯(Mark D. Smith)稱。
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