Georgia faces a huge supply-and-demand challenge under health reform, a new statistical analysis has found. The data show that Georgia has the second-largest problem...

Georgia faces a huge supply-and-demand challenge under health reform, a new statistical analysis has found.

The data show that Georgia has the second-largest problem among states in offering enough primary care medical providers for the number of residents who will be newly insured under reform.

Starting in 2014, when reform is fully implemented, the state is projected to add more than 600,000 new enrollees to its Medicaid rolls. But Georgia, with physician shortages, currently has “weak primary care capacity,’’ according to the article presenting the data, published in the New England Journal of Medicine.

If there are not enough primary care physicians, nurse practitioners and physician assistants available, states such as Georgia could be overwhelmed by the new demand for medical services, the article said. The surge in demand for doctors could also limit access to medical care for patients with private insurance.

Georgia, along with 27 other states, is fighting the health reform law in the courts. The Medicaid expansion is one of the reform provisions that the states oppose, citing increased costs.

Leighton Ku, lead author of the journal article, said Friday in an interview that the data were intended to ‘’sound the alarm’’ for states to prepare their medical systems for health reform. Even if the insurance expansion doesn’t occur, Ku said, “it’s still a good thing if Georgia beefs up its primary care supply.’’

One reason why some states currently have so few primary care physicians (including family practice doctors, internists, pediatricians and ob/gyns) ‘’may be that high rates of uninsured residents and poverty make it harder. . .to attract and retain practitioners,’’ the article says.

Georgia’s uninsured rate is about 20 percent of the population. Health reform would raise the Medicaid eligibility ceiling for non-elderly adults to 133 percent of the federal poverty level, or roughly $30,000 in annual income for a family of four.

The NEJM article’s ranking lists these states as having the biggest challenge of building enough primary care capacity before 2014:

1. Oklahoma

2. Georgia

3. Texas

4. Louisiana

5. Arkansas

6. Nevada

7. North Carolina

8. Kentucky

9. Alabama

10. Ohio

Ku, a health policy professor at George Washington University, said such states should try to make primary care more attractive for doctors, especially in underserved areas. He noted that the primary care supply in the Atlanta suburbs, where more patients have private insurance, is much better than in the rural areas of the state.

Georgia serves fewer patients in community health centers than other states, Ku added.

The state’s population is increasing faster than its supply of primary care doctors, said Cherri Tucker, executive director of the Georgia Board for Physician Workforce, which tracks data on doctors in the state.

She noted that the number of internal medicine physicians in Georgia had shrunk from 30.53 per 100,000 people in 2004 to 26.22 in 2008, the latest year the data were available.

Ob/gyns dropped from 13.48 to 10.92 per 100,000 over that same time frame.

Georgia’s medical schools are increasing enrollment but medical residency programs are not expanding, Tucker said.

Primary care supply gaps occurred in Massachusetts when its state health insurance reform was enacted. “They were not ready,’’ Ku said. “Many patients found it took longer to see a doctor.’’

Massachusetts is coping with the supply problem better now, through expansion of community health centers, among other things, he said.

Ku acknowledged that as the physician supply challenge arises, states are simultaneously experiencing severe budget crunches. “It’s going to make things a little harder to get ready,’’ he said.

Georgia’s tight 2012 budget proposes a 1 percent payment cut for physicians delivering Medicaid services.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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