As the 31st State Expands Medicaid: Do We Need to Be Concerned About a Physician Shortage?

Recently, Montana became the 31st state, including D.C., to expand Medicaid. Discussion regarding Medicaid expansion is ongoing in one state: Utah. Nineteen (19) states have rejected Medicaid expansion, including NC.

When Medicaid expansion was first introduced, it was a highly polarized, political topic, with Republican governors, generally, rejecting expansion and Democrat governors, generally, accepting expansion.

Now, however, many Republican governors have opted to expand Medicaid. There are currently 31 Republicans, 18 Democrats, and one independent that hold the office of governor in the states. Yet, 31 states have expanded Medicaid. Here is an extremely, difficult-to-read chart outlining the states that have opted to expand, those that have opted to reject expansion, and the one state (Utah) still discussing:

caid expansion1medicaidexpansion2

I know, it’s hard to read. Feel free to go to the actual Kaiser website to see the chart readable by humans. (Microsoft’s “Snipping Tool” leaves much to be desired; Apple’s “Screen Shot” is much better, in my opinion).

An interesting fact is that, in its first week with Medicaid expansion, Montana had over 5,500 people sign up for Medicaid.

Another interesting fact is that, approximately 18,078 physicians graduate from medical school in America per year.  But in Montana?


N/A…as in, none. Not applicable. You see, Montana does not have a medical school. It does participate in the Washington, Wyoming, Alaska, Montana, and Idaho collaborative program. However, the collaborative program does not do a stellar job at recruiting physicians to Montana. It tries. But the statistics are stacked against Montana.

“Sixty-eight percent of doctors who complete all their training in one state end up practicing there,” according to the Association of American Medical Colleges.

Yet Montana has no medical school. And expanded Medicaid. If any of you ever took economics, there is this accepted theory called, “supply and demand.”


Supply and demand dictates that, when supply is low and demand is high, the product, whatever it is, can be sold at the highest price. Medicaid expansion, however, is creating an anomaly. Medicaid expansion expects a higher demand to meet the lower supply without increasing the reimbursement rates. This is a fundamental flaw in Medicaid expansion. If, on the other hand, Medicaid expansion was premised on an increase in reimbursement rates, we may see an uptick in supply. When demand is high and supply is low, many people “demanding” get nothing.

Let’s think about how many patients each primary care physician can handle.

“According to a 2013 survey by the American Academy of Family Physicians, the average member of that group has 93.2 “patient encounters” each week — in an office, hospital or nursing home, on a house call or via an e-visit. That’s about 19 patients per day. The family physicians said they spend 34.1 hours in direct patient care each week, or about 22 minutes per encounter, with 2,367 people under each physician’s care.” See article.

physician need

“The baseline projections from BHPr’s physician supply and requirements models suggest that overall requirements are growing faster than the FTE supply of physicians (Exhibits 51 and 52). Between 2005 and 2020, requirements are projected to grow to approximately 976,000 (22 percent), while FTE supply is projected to grow to approximately 926,600 (14 percent). These projections suggest a modest, but growing, shortfall of approximately 49,000 physicians by 2020 if today’s level of health care services is extrapolated to the future population. ” See article.

This is not the first time I have noted the increasing physician shortage with Medicaid expansion. There is a huge difference in giving someone a Medicaid card and providing a person with quality health care. A card is a piece of paper. If you cannot find a physician..or psychiatrist…or pulmonologist….or neurosurgeon who will accept Medicaid, then your Medicaid card is simply a piece of paper, not even worth the paper upon which it is printed. See blog. And blog. And blog.

The same can be said with the shortage of dentists. See blog.

With a shortage of approximately 49,000 physicians in 2o20, I pray that I am not holding a Medicaid card.

If I am, I will be another victim of high demand with low supply.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 12, 2015, in Access to Care, Affordable Care Act, Federal Government, Federal Law, Knicole Emanuel, Legislation, Medicaid, Medicaid Attorney, Medicaid Costs, Medicaid Eligibility, Medicaid Expansion, Medicaid Providers, Medicaid Reform, Medicaid Services, Montana Medicaid, NC, North Carolina, Physicians, Primary Care, Primary Care Physicians, Psychiatrists, States, Tax Dollars and tagged , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 3 Comments.

  1. This was interesting to see and analyze a little. I noticed that there seems to be some “regionality” to which states did or didn’t adopt expansion. All the Southeast coastal states starting with VA and working on down and around the Gulf to Texas (+TN) chose not to expand. It would be even more interesting to analyze why with one factor being the status of each of these state’s economy.

  2. Readers, I was informed that there is a physicians assistant program in Montana.

  3. Hmm, the figure is a price versus quantity-demanded relationship. But it could stand in for a demand-supply curve.

    Physician supply and demand is a bit more tricky than a price-demand relationship as there is also a fairly well accepted theory called “physician-indced demand” which is invoked usually when coverage expansion happens or rates go up or doctors don’t meet their “target income.” But it is also controversial. The HRSA report you refer to has a few problems with arithmetic and its assumptions. If a doc can see 93.2 encounters per week and they work 50 weeks a year and there are 316,000 primary care docs, then that’s almost 5 visits per year per all person in the US–for just primary care docs. Of course docs don’t work all that much and not everyone sees a primary care doc in any given year…but add up all the docs and all the visits they could produce and then cut the numbers in half and you get a lot of visits–way too many.

    There indeed are shortages of doctors in a lot of places and for people who have only one kind of insurance–but that is a function of physicians not going where they are “needed” and wishing to reach that target income. There are also large concentrations of physicians in places near where you I’ve and the docs there work hard to stay busy by doing things that might not be the best thing for their patients.

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