Doctors shortage expected to worsen with surge of new patients

By Akeya Dickson NNPA Washington Correspondent

WASHINGTON, D.C. (NNPA) – As more people become covered as a result of the Affordable Care Act recently upheld by the United States Supreme Court, the current shortage of physicians is expected to worsen, according to medical experts.

“We have a looming shortage of primary care physicians in this country,” said Esther Dyer, executive director of National Medical Fellowships. “Within the next five to six years there will be a shortage of at least 40,000 primary care physicians.”

But that was expected before last Thursday’s landmark court decision that paves the way for 32 million newly-insured Americans to begin receiving health services.

The Association of American Medical Colleges now says the physician shortage is “projected to climb to more than 90,000 by 2020.”

Physician shortage is hardly a news flash but certainly a reality now. Health care professionals and advocates have long advocated solutions for reversing the physician shortage, including loan forgiveness and scholarship programs to assist potential medical students.

Further complicating the physician shortage is the roughly 80 million baby boomers aging into retirement. With a shortage of doctors opting to go into primary care and the fact that many of the existing primary care doctors are baby boomers themselves only compounds the problem.

The medical community has called for an increase of the number of government-sup-ported residencies to help replace some of those retiring physicians and the Association of American Medical Colleges hopes to increase medical school enrollment 30 percent by 2013. “More medical students are going into specialties versus primary care. Many students are choosing other careers in terms of choosing specialty

Despite the expected rush of millions of new patients entering the system, many medical professionals have expressed enthusiasm about the court decision. Dr. Cedric Bright, president of the National Medical Association, which represents Black physicians, said in a statement released the day of the ruling:

“The ACA is working. More seniors can now afford their meds. Young people can stay on their parents’ health plans until age 26,” said Bright, who is also the Assistant Dean of Special Programs and Admissions in the Department of Medical Education at the University of North Carolina at Chapel Hill School of Medicine.

He added, “Insurers no longer deny coverage because of preexisting conditions, or drop people because they get sick. We are doing a better job of coordinating care, and we now have better prospects for preventing chronic disease.”

Health Affairs magazine, in a report, titled “The Affordable Care Act’s Coverage Expansions Will Reduce Differences in Uninsurance Rates by Race and Ethnicity,” found that 21.6 percent of African-Americans are without health insurance, compared with 13.9 percent of Whites and 33.3 percent of Latinos.

Overall, 50.3 million Americans are uninsured, a figure that is projected to drop to 26.4 million now that the Affordable Care Act has been upheld. Medicaid and the Children’s Health Insurance Program (CHIP) coverage will account for “disproportionately large gains in coverage” among Black people. An 8.4 percent increase is expected in coverage of Black people by these two programs, rising to 36.5 percent.

There is an acute shortage of physicians of color.

According to data from Kaiser Permanente, while 14 per-cent of the population is Black, only four percent are physicians. Similarly, 16 percent of the population is Latino, while only five percent of physicians are Latino.

Once called “AIDS wasting,” weight loss is a sign of more advanced illness and could be due in part to severe diarrhea. If you’re already losing weight, that means the immune system is usually fairly depleted. A person is considered to have wasting syndrome if they lose 10 percent or more of their body weight and have had diarrhea or weakness and fever for more than 30 days, according to the U.S. Department of Health and Human Services.

7. Dry cough
A dry cough can be an early first sign that something is wrong. And at first it can be dismissed as bad allergies. But if it goes on for a year and a half—and keeps getting worse—something’s wrong. Benadryl, antibiotics, and inhalers didn’t fix the problem. Neither do allergists. This symptom—an “insidious cough that could be going on for weeks that doesn’t seem to resolve,” —is typical in very ill HIV patients.

8. Pneumonia
The cough and the weight loss may also presage a serious infection caused by a germ that wouldn’t bother you if your immune system was working properly. There are many different opportunistic infections and each one can present differently. Other opportunistic infections include toxoplasmosis, a parasitic infection that affects the brain; a type of herpes virus called cytomegalovirus; and yeast infections such as thrush.

9. Night sweats
About half of people get night sweats during the early stages of HIV infection. These can be even more common later in infection and aren’t related to exercise or the temperature of the room.

Similar to the hot flashes that menopausal women suffer, they’re also hard to dismiss, given that they soak your bedclothes and sheets.

10. Nail changes
Another sign of late HIV infection are nail changes, such as clubbing (thickening and curving of the nails), splitting of the nails, or discoloration (black or brown lines going either vertically or horizontally). Often this is due to a fungal infection, such as candida. Patients with depleted immune systems will be more susceptible to fungal infections.
11. Yeast infections
Another fungal infection that’s common in later stages is thrush, a mouth infection caused by Candida, a type of yeast. It’s a very common fungus and the one that causes yeast infections in women. They tend to appear in the mouth or esophagus, making it difficult to swallow.

12. Cold sores or genital herpes
Cold sores (oral herpes) and genital herpes can be a sign of both ARS and late-stage HIV infection. And having herpes can also be a risk factor for contracting HIV. This is because genital herpes can cause ulcers that make it easier for HIV to enter the body during sex. And people who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system.

13. Tingling and weakness
Late HIV can also cause numbness and tingling in the hands and feet. This is called peripheral neuropathy, which also occurs in people with uncontrolled diabetes. This is when the nerves are actually damaged. These symptoms can be treated with over-the-counter pain relievers and antiseizure medicines such as Neurontin (gabapentin).

14. Menstrual irregularities
Advanced HIV disease appears to increase the risk of having menstrual irregularities, such as fewer and lighter periods.

These changes, however, probably have more to do with the weight loss and poor health of women with late-stage infection rather than the infection itself.

Infection with HIV also has been associated with earlier age of menopause (47 to 48 years for infected women compared to 49 to 51 years for uninfected women).