The Republicans and Democrats have been putting on a demonstration of the blind men and the elephant with their remarks about the Supreme Court ruling on the constitutionality of the Obama health care plan.

To the Democrats the plan helps everyone.  To the Republicans the plan harms every one and will endanger small businesses.

Unfortunately neither the Republicans nor the Democrats have examined the implications of this plan on patient loads for physicians, specialists, dentists, and nurses.

The new “Obamacare” plan will increase the number of U.S. patients for insured medical care by about 30% when it becomes fully active.  However there will be no increases at all in the numbers of physicians, specialists, dentists, or nurses.

There will be a number of unintended consequences of the new plan that both the Democrats and Republicans have totally ignored.  Here are the more serious consequences:

  • Some, probably most, newly insured patients will have trouble finding a primary care physician.‬
  • Many newly insured patients will have trouble finding specialists, and especially so for specialties where there is already a shortage such as obstetrics and gynecology.‬
  • ‪Currently insured patients who move to other states and other communities will have trouble finding physicians, specialists, and dentists who will accept them as patients.‬
  • ‪Hospital care may decline due to increased patient loads but no increases in nurses.‬
  • ‪Mandatory overtime for nurses will probably increase significantly due to more patients.  This is serious because nursing shortages are accelerating due to increasing retirement rates for nurses.‬
  • ‪Wait periods for elective surgery will stretch out by perhaps 50% compared to 2012.‬
  • ‪Specialized surgical procedures such as cochlear implants will probably become harder to find if hospitals have shortages of surgeons, OR nurses, and operating rooms.‬

Rhode Island is particularly vulnerable to higher patient loads because we already have shortages of physicians, specialists, nurses, and dentists.   This is due in part to our high taxes and in part to the fact that our insurance reimbursements are the second lowest in America, after Arkansas.

Every physician and dentist I know says that it is extremely difficult to attract young practitioners to Rhode Island when every other New England state has lower taxes and higher insurance reimbursements.

Rhode Island also has an increasingly high retirement rate among nurses, combined with long wait periods to enter nursing schools which discourage some would-be nurses.

There have been hundreds of articles either praising or criticizing the new Obama health care plan, but I have not seen any at all that discuss the quantitative results of increased patients loads combined with constant or declining numbers of physicians and medical personnel.

It is troubling than none of the Rhode Island congressmen have even addressed this problem.  One would expect that our delegates would be discussing what Rhode Island can do to reverse our shortages of medical personnel, but so far I have not seen anything from anyone.

These problems are not hard to study because they have already occurred in the United Kingdom, Canada, and many other countries.   It is astonishing that no one in the U.S. government seems aware of what will happen when patient loads go up and medical personnel stay flat or decline.

Summary and Conclusions

Whether or not the Obama health care plan is a good thing or a bad thing, it is going to occur in the United States for at least a period of years.   Putting aside financial and constitutional issues, the Obama health care plan will raise patient loads but does nothing at all to increase the numbers of physicians, specialists, dentists, and nurses.

The inevitable consequence of the new Obama plan will be increasing difficulty in finding physicians who will accept new patients, increasing delays in many elective medical and surgical procedures.

Possibly the most serious unintended consequence will be much tougher working conditions for nurses, which might discourage new nurses from entering the field.  Nursing shortages may also degrade hospital care or at least cause fatigue and overwork among hospital nurses.

NOTE:  Article was published previously in RI.


  1. The case presented presents two outcomes as I see it. One, nurse salaries will have to rise to re-attract a new generation of Nurses. Two, a shortage of medical professionals will lead to waits and delay in appointments and subscription services.

    It is the second effect that bothers me most. It this were a temporary effect, it would be an annoyance. If the temporary problem masked a larger risk, that reducing the cost of medical care begins gutting a medical system as under payment slowly robs it of health, it may take us years to see whether changes in Medical care systems have hollowed out US medine.

    Wishful thinking in business planning for medicine actually is medically dangerous. A hospital that cannot receive the true costs of medicine hollows out its services or must choose to skip paying its Doctors, Nurses and Suppliers and so goes under. Then, the community health suffers from a business consequence. Over concentration of patients and fail over services sites extends the delay and distance of Medical staff from the patients they serve. Again, a lack of fair payment is a bad move that keeps on rippling toward failure of medical teamwork and of consequence silent killers through patient harm.

    I hope that this case is a limited risk and that I am over concerned with a low probability outcome. What happens if I am not over concerned? What is in place to prevent this? Is this not the very heart and benefit of genuine risk management to consider the question for even just a few seconds?

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