In the wake of the passage of the health reform bill this week, one item that’s hit the radar is a report that health reform may cause physicians to leave practice in large numbers.  The report, which suggested that as many as 46% of physicians would try to leave medicine, originally received exaggerated attention when it was erroneously attributed to the New England Journal of Medicine.

The actual research was performed by medical recruiting firm Medicus.  The firm published their survey and results in greater detail in response to the high levels of interest.  Respondents indicated that, if health reform were enacted with a public option (the survey was performed when that option was still on the table), 24% would attempt to retire early and another 21% would attempt to leave practice even if not near retirement age.  As enacted, 22% indicated an interest in retiring early and another 8% would attempt to leave medicine without being near retirement age.

Still, a loss of “only” 30% of physicians would be tragic.  Even assuming that the number is greatly overstated through methodological issues and wishful thinking on the part of respondents, the accelerated loss of physicians from practice in the U.S. will cause significant issues.

You see, even without the loss of any physicians, we’re heading towards a physician shortage.

At some level, we’ve been headed in that direction for some time.  We’ve only been able to staff our current physician needs by pulling large numbers of physicians from other countries.  Foreign nationals have come to the U.S. for many years for medical training and many have stayed.  As the financial situation for many clinicians has become more difficult and the financial opportunities in their native countries have improved, more and more have opted to return home after their training.

Now, this collides with health reform.  Looking at the test case for health reform – Massachusetts – we find that the healthcare system lacked the care providers to cover basic services for the large numbers of newly insured patients.

In other words, whether or not physicians begin leaving medicine, near-universal health coverage is going to cause changes to medicine.  Use of second-tier providers, such as nurse practitioners and physician assistants, is going to increase, particularly in primary care.  The system as a whole is going to need to become more efficient in its management of patients, using technology to replace low-value patient encounters.

What happened this week in health reform is a beginning, not an end.  I don’t think anyone yet knows just what it’s going to look like when all of the pieces come together.  The only thing that we know for sure is that things can’t stay the way that they’ve been in the past.