Mar. 29--CHARLESTON, W.Va.--The national health care reform may provide millions of Americans with insurance, but that doesn't mean there will be enough doctors to see them.
In West Virginia alone, about 200,000 currently uninsured residents are supposed to obtain insurance by 2019.
But their newfound ability to afford a trip to the doctor is likely to exacerbate the state's doctor shortage.
Currently, the Mountain State has about 170,000 residents living in areas designated by the federal government as having a shortage of doctors, according to data from the Kaiser Family Foundation.
Doctors, especially primary care physicians, can expect a spike when those newly insured people start coming in for regular checkups they formerly couldn't afford.
The head of the state's largest private insurer said it will be tough to meet the demand.
"I think you have a real supply issue," said Fred Earley, the president of Mountain State Blue Cross Blue Shield.
"I think we have a real concern over whether we have the number of physicians or primary care providers to provide the care for all these additional people that are going to be accessing the health care system."
Evan Jenkins, the executive director of the West Virginia State Medical Association, which represents about half of the state's doctors, said while many people support expanding the number of people covered by insurance, the expansion will not occur without problems.
For instance, Massachusetts adopted its own health care reform package several years ago, and the expansion ended up highlighting a doctor shortage.
"Similar to the experience in Massachusetts, once you have coverage, that does not necessarily mean you have ready access to a physician," Jenkins said.
The shortage is especially prevalent in rural areas, where there is less incentive for doctors to set up shop.
There also is a shortage of primary care physicians -- those who do regular checkups and practice family medicine -- because of a national trend for medical students to choose more lucrative specialties.
Jenkins says that because many now-uninsured West Virginians will obtain coverage through an expansion of Medicaid, the federal-state program for the poor, there could be other problems.
Doctors know Medicaid for its relatively low reimbursement rates. While the national reform is set to increase those rates for primary care physicians, it may not be enough to stop doctors from trying to recoup money by increasing bills for patients with private insurance plans, like Blue Cross Blue Shield.
Jenkins said that could drive up premiums for those people. He said doctors also could stop accepting patients who receive Medicaid.
"We are going to have challenging times in the future in making sure people get the care they need, when they want and where they want," he said.
Part of the savings the federal government hopes to see from health care reform is through preventive care. Because they have insurance, people are expected to go to doctors more for regular checkups and early on when they feel ill. Proponents argue that will cut down on expensive emergency room trips and treatment of catastrophic illnesses.
However, when the insurance rolls grow in 2014, officials expect a surge in doctors' visits. That is based on studies of retirees who have gone off their employer-backed health insurance but are not yet 65 and eligible for Medicare, the federal program for seniors.
"What we would anticipate is that when they have the ability there will be a pent-up demand and then it will settle down," said Nancy Nielsen, the immediate past president of the American Medical Association.
She added, "The truth is we want people to come in for preventive care, for early treatment."
This could alleviate pressures on emergency room doctors, who are currently handling patients who try to stick out routine illnesses and end up sicker. But it also could further highlight the overall shortage of doctors.
Nationally, the nation needs to have about 30 percent more doctors going into medical schools, according to estimates from the Association of American Medical Colleges.
Without such an increase, the group expects a nationwide shortage of 120,000 physicians by 2025.
Nielsen cautioned that similar workforce estimates have proven wrong before but the country still needs to both train more doctors and have more of them interested in primary care.
"I don't think we need to worry about the actual numbers as much as the trend," she said.
One problem, she said, is that residencies are funded by Medicare and the number of slots for doctors-in-training has been capped by the federal government. Nielsen said the current cap needs to be raised -- a potentially expensive proposition.
One promising sign she sees is an increase in the number of medical residents heading into primary care.
However, any large turnaround will take time, she said, because doctors spend several years in school, then a couple more in training. This means changes that begin today to increase capacity at medical schools will not produce results until, perhaps, the mid-2020s at the earliest, Nielsen said.
Perry Bryant, the executive director of West Virginians for Affordable Health Care, notes while there may be a shortage of doctors, there also could be more reliance on nurses to provide care.
Chuck Thayer, the acting assistant director of the state's Office of Community Health Systems and Health Promotion, said he's focusing on non-profit community health centers, which are expected to handle a fair share of newly insured patients.
Those government-backed centers are in places with a shortage of primary care doctors. The 175 centers in the state served 327,048 West Virginians in 2008, according to the most recent data available from the National Association of Community Health Centers.
The federal government is providing money to expand the centers and beef up recruitment, but Thayer and others are waiting to see what happens when tens of thousands of West Virginians and millions of Americans actually have insurance.
"I think that's one of those things that we'll know it when it's here and we'll find out the hard way," Thayer said.
Contact writer Ry Rivard at ry.riv...@dailymail.com"ry.rivard@dailymail.com or 304-348-1796.
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