Editor's note: This is the second in a three-part series about the effects of the Obama administration's health-care reform on Huntington Beach and Fountain Valley health-care providers and their patients.
Dr. Peter Anderson sometimes goes for days in Fountain Valley Regional Hospital and Medical Center's emergency room without treating an emergency. It's not for lack of patients.
Anderson, the director of the hospital's emergency department for 35 years, has seen increasing numbers of people check in with ailments that traditionally would be handled by a family doctor. Instead of X-raying ankles or stitching wounds, he examines chest pains and bladder infections while the suture tray goes untouched.
The reasons for that are usually twofold: Most of the people packing Anderson's facility either can't afford insurance or can't get a doctor's appointment soon enough.
The health reform signed by President Obama in March, which will expand insurance to nearly all Americans, aims to lighten the load for emergency rooms by diverting more people to the doctor's office. But Anderson is skeptical about how that will work. He pointed to media reports about overcrowded emergency rooms in Massachusetts after the state passed a health-care reform package similar to Obama's in 2006, and said that with only so many doctors to go around, he wouldn't be surprised if many of the new people on the insurance rolls head straight to his doorstep.
"It's hard to say that, with this new health-care system, there is going to be a decrease in the emergency department," Anderson said.
A prescription for uncertainty
Anderson is not the only one in town — including even reform supporters — wondering how well the White House's health-care fix is going to work.
Some hospital administrators in Huntington Beach and Fountain Valley have expressed gratitude for the government's attempt to fix what they consider a badly flawed system, but also wariness about whether the reform can meet all its goals. And nearly everyone seems to agree on one point: The changes Obama signed into law will not be the last ones needed for America's health-care system.
"It was a good first step," said Barry Arbuckle, the president and chief executive of MemorialCare Health System, which oversees Orange Coast Memorial Medical Center in Fountain Valley. "I think, in people's minds, it's kind of this overarching, comprehensive thing, and it's not. But in all fairness, we can't expect what Obama and his team signed [in March] to be an end-all, be-all. This thing is going to be changed and altered so many times in the coming years.
"But this was a big step, no doubt about it."
How will that big step play out in Huntington Beach and Fountain Valley? Here are local reactions to four key parts of the reform:
Putting primary care first
The government aims to boost the workforce by offering scholarships and other financial incentives to people seeking careers as primary care doctors, nurses or assistants. On June 16, Department of Health and Human Services Secretary Kathleen Sebelius announced a $250-million investment to create 500 new primary care residency slots by 2015, support the development of more than 600 new physician assistants and encourage more than 600 students to pursue full-time nursing careers.
Jon Gilwee, the senior director of government health-care programs at UC Irvine Medical Center, acknowledged that a disproportionate number of students opt for specialist careers over primary care. Of the 99 graduates who entered residency programs at UCI Medical Center this year, just 32 went into primary care fields, according to UCI spokesman Tom Vasich.
"To find someone and make it attractive to go to medical school for all the years of training, and line that up with what someone might make in a primary care setting versus what somebody is going to earn and have the potential to earn in a surgical specialty, there's a significant disparity," Gilwee said.
Given the large number of people who apply to the UCI School of Medicine, Gilwee said he didn't imagine the campus would have to do any more recruiting for future primary-care workers. He noted, though, that UCI might apply for residency slots unused by other campuses if they're available, a practice permitted by the reform.
But to Richard Afable, the president and chief executive of Hoag Memorial Hospital Presbyterian, even an influx in primary care training won't cover all the patients that the reform will create. Like Anderson, he expects most of those new enrollees to end up filling the emergency room.
"If we started providing an appropriate proportion of primary care doctors through our medical schools tomorrow, it would take 10 years to even get close to the number of primary care doctors we need in this country," said Afable, who oversees Hoag Health Center in Huntington Beach.
More promising to him are some of the measures the government is taking to improve the efficiency of patient care itself, such as "accountable care organizations," in which doctors, hospitals and other providers work together to monitor a patient's health over time; bundled federal payments to hospitals, which cover 30 days of post-hospitalization care for Medicare recipients; and the "medical home" pilot program, which funds coordinated care at community health centers.