Dear Goddess, the shortage of primary care doctor is already at hand. I shudder what I would do when my current doctor retires.

" . . .in the years to come."

I agree with BigFire; the shortage is here NOW.

Oh wait, you did say HUGE shortages. Yep, it is only going to get worse - much worse.

To which I will add my own prediction - no matter what, the Democrats, the news media, and others will find a way to blame it on either/both the Republicans and "greedy" healthcare providers.

There are many primary care doctors that are setting up concierge medical practices. They don't accept insurance and have a monthly/annual fee and either none or a small fee for office visits.

Then you take the rest of the money that you would pay for insurance and save it.

There was one guy I heard of that needed knee surgery. He negotiated with the doctor and hospital to have it done for $15K. The hospital accidentally sent him the bill they would have charged the insurance company. It was about $90K.

So this once again proves that health insurance is not health care.

Actually, even if there was no "shortage" of doctors there is a substantial disincentive for Doctors to accept "health care" exchange insurance plans. After paying the first month premium the individual is given a 60 day grace period to pay future premiums. During that grace period the insurance is required to pay providers. If the individual does not pay the premium after 60 days their coverage is ended, and the providers that were paid during the 60 day grace period have to pay the insurance company back. So, ask yourself if you would be willing to take on patients with "health care" exchange insurance.

Medicare has had the problem for quite a while now, but I have heard ACA is going to make it much worse also.

My Medicare "Primary Care Physician" is actually an outpatient clinic at a local hospital, perhaps could work for these people as well?

Entry into a profession with high pay and status, like doctor, is very competitive. As doctor income and status go down, the most competitive people, with the most intelligence and ability, will look for more $$rewarding opportunities elsewhere, like maybe in politics or the medical insurance industry, or some symbiosis of the two. This will open the door to becoming a doctor to less competitive candidates who wouldn't have made the cut before. "Leaders" will further mitigate the shortage by lowering the standards for entry into the profession. In the future, doctors will be dumber.

In the future, doctors will be dumber.

Say hello to Dr Lexus

https://www.youtube.com/watch?v=qkPGlVqqEP0

A quote from one of the strikers in Atlas Shrugged seems relevant here:

"I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it - and still less safe, if he is the sort who doesn't."

As long time readers know, I'm not surprised at all – because the current healthcare scan is based on a fraudulent idea.

The real reason for "insurance" is to pay doctors. No more, no less.

Since the deductible is so high, on the ACA policies, co pay will be one hundred percent for anyone insured under it until they hit that threshold. Any doctor, that does not get payment up front either in cash, or on a valid credit card, will not be seeing any ACA insured patients, unless the doctor and the hospital are either idiots, or it is an emergency where they cannot deny care.

Expect emergency room visits to double or triple, as medicaid, medicare, and ACA patients use that as their primary care giver.

Primary care has already been punted from doctors to nurses and PAs (physician's assistants)a good percent of the time. Both require less training and are great choices for some things (heck, I could run a rapid strep test if I could GET a test). In some ways, it is a change I welcome. Do I actually need a doctor to check my kid's ear for infection, or will a nurse do just as well?

That said, getting to see an actual doctor when you need to see an actual doctor is becoming problematic even in specialist offices. Both my kids have specialists and even in the DC area (i.e. not some rural area lacking in advanced medical offices/hospitals/equipment) it can be 6 months or a year to get in, and even THEN we'll likely be seeing a PA or nurse.

Thanks for that Rand quote, Rex.

Now here's Ayn Rand accepting government handouts under her oft-unused married name.

Suckling at the taxpayer's teat in her own enlightened self-interest...

The inability to find a doctor within your plan's network had been a problem for a while.

In 2007 it took me several weeks to find a doctor in my city was accepting new patients. Once I did, I had to wait more than a month to get an appointment. When I moved to my current city in 2010, I was able to find one rather quickly, but had to set an appointment for more than a month in advance. It was rescheduled twice, pushing the wait out to nearly 2 months.

With even more people getting insured, the problem is sure to grow, but it's been around since long before Obamacare.

When I had a high-deductible plan, I had the best luck just walking into urgent care and negotiating a lower out-of-pocket rate in exchange for up-front, in-full payment.

To be clear, with regard to specialists, I wasn't talking about in-network. I was talking about ANY doctor.