In 2006, Massachusetts enacted a law that vastly reduced the number of uninsured Bay State residents. There was one slight problem though. Scads of the newly insured couldn’t find primary care doctors to take care of them.

Wait times for routine office visits have soared in some parts of the state to 100 days and many residents have simply given up trying to find one.

These folks end up seeking care in ERs which is what they did before they were covered.

The problem scares the bejeesus out of officials in the Obama administration, who know that if the Big O has his way and 40-50 million Americans acquire health insurance in the blink of an eye, the same problem will play itself out nationwide.
 
What to do? Some suggest bumping medical school enrollment which would begin addressing the problem around the time the Big O wraps-up his second term, and that’s assuming any of the new graduates actually enter primary care.

Others recommend increased utilization of nurse practitioners and physician assistants, but last time we checked all these types are already happily employed, and training new ones is associated with lag time problems of its own.

Solutions with a quicker onset of action include expanding RN-staffed retail clinics with leveraged physician oversight, and opening the doors even more widely to foreign medical graduates.

Some even suggest overhauling the payment structure for physicians in a way that incents specialists to do some primary care.

Assuming policymakers have the stomach to take on physician payment reform in a way that doesn’t cause system-wide costs to skyrocket, the idea won’t go down well with specialists, regardless.

Listen to Peter Mandell, for example. The spokesman for the American Association of Orthopedic Surgeons told the New York Times, “we have no problem with financial incentives for primary care (but) if there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

Just 6 years after scientists decoded the human genome, a line of research derived from the breakthrough known as personal genomic medicine is increasingly perceived to be an expensive bear with an uncertain future, according to commentaries in the New England Journal of Medicine.

Since the heralded announcement in 2003, geneticists have undertaken hundreds of genomewide association studies designed to compare the DNA of healthy people with those of patients having specific diseases.

The hope was to pinpoint a handful of culprit genes and by association, biochemical processes that could become targets for disease-modifying drugs, immune therapy or what have you.

But the studies appear capable of explaining just a fraction of the genetic component underlying complex diseases like cancer, schizophrenia and diabetes.

The problem, it seems, has been the assumption that such conditions were promoted by variations in a small number of genes, say 10. Instead, thousands of genes appear to be involved, with multiple variations at each locus exerting myriad effects on other genes and their variants.  

The snafu represents a setback for personal genomics companies that hoped to inform customers about their risk for these diseases.

“With few exceptions, what the genomics companies are doing right now is recreational genomics,” Duke University geneticist David Goldstein told the New York Times. “The information has little or…no clinical relevance.”

In his NEJM piece, Goldstein therefore recommends a strategic shift in genomics research towards decoding the entire DNA of patients with certain diseases.

But Peter Kraft and David Hunter of the Harvard School of Public Health, publishing in the same issue, remain optimistic about genomewide association studies.

“There will be more common variants to find,” Hunter told the Times. “It would be unfortunate if we gave up now.”