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.
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.
美国其他地区，包括密西西比三角洲、底特律以及凤凰城郊区，都面临同样的问题。美国医学院协会(The Association of American Medical Colleges)预计，2015年全国将出现6.29万名医生的短缺。到2025年，随着保险范围扩大以及婴儿潮人群老龄化引发医疗护理需求的增长，这个数字将增加一倍。即使没有医疗法案，2025年医生的短缺数量仍将超过10万人。
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.”
“除了整形和皮肤科医生外，我们各种医生都缺，”加利福尼亚大学里弗赛德分校医学院院长G.·理查德·奥尔兹(G. Richard Olds)称。这所新医学院的成立在一定程度上就是为了解决该地区医生资源匮乏的问题。“10年内，无论怎样努力，我们都将有着5000名医生的缺口。”
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.”
“这引发了治疗延后以及病情恶化，”加州医学会(California Medical Association)的负责人达斯廷·科科伦(Dustin Corcoran)称，该医学会有3.5万名医生成员。人们“进入医疗系统要通过急诊部，而不是靠和给他们提供日常医疗保健的初级保健医生建立关系，而这些医生本可能防止病人的病情进一步恶化。”
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.”
“美国老年人对医疗服务的需求量远超从前，”美国医学院协会会长达雷尔·G.·基尔希(Darrell G. Kirch)称。“老年人更可能患有有多种慢性疾病，需要更深入、协调的治疗。”
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.
医生的工资也是一个问题。过去15年中，医学院学生选择从事初级保健医疗的数量已经减少，因为初级保健医生和骨科医生、放射科医生等专科医生相比，他们之间的工资差距在拉大。医疗集团管理学会(Medical Group Management Association )的一项研究发现，在2010年，初级保健医生的年薪约为20万美元，而专科医生的年薪一般都在这个数字的两倍左右。
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.
加州的很多卫生专家称，他们虽然欢迎扩大医疗保险覆盖范围，但预计该州还没有准备好去满足这些新的需求。因为医生的短缺，我们“应该更加明智地利用现有资源，”非营利性组织加州医疗基金会(California Health CareFoundation)的负责人马克·D·史密斯(Mark D. Smith)称。