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September 21, 2012


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Start from a shortage of PCPs by the end of the 1970s / early 1980s. (I suspect earlier; I remember my 96%-WhitenotLatino home town advertising for GPs by the time I left Junior High.)

We have had 30+ years of subsidizing specialist (effectively at the expense of PCPs) from the largest payer for health-care services.

We have had twenty years (1994) since doctors--especially PCPs-- learned their future payments from the =other= source (private insurers) were going to be reduced significantly.

PPACA addresses the first imbalance some, shifting payments back toward PCPs. But the "new equilibrium" won't come quickly.

The "Northern Exposure" solution doesn't work well for citizens, but it's got real potential for overseas MDs. Given that as the other option, I suspect APRNs (and especially NPs) would become the legislature's preference.

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