This was a no-brainer from the start of the debate over the Obamacare bill but Democrats refused to listen and the consequences are going to be awful.
As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients.
Some lawmakers want to fill the gap by redefining who can provide healthcare.
They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.
"We're going to be mandating that every single person in this state have insurance," said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. "What good is it if they are going to have a health insurance card but no access to doctors?"
Hernandez's proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.
Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.
"Patient safety should always trump access concerns," said Dr. Paul Phinney, president of the California Medical Assn.
Such "scope-of-practice" fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.
There is already a serious shortage of GP's in rural areas and Obamacare is going to make that situation a crisis. With cuts in Medicare payments to doctors and hospitals, as well as reduced payments in many states under Medicaid, treating the millions of new patients who come on board when Obamacare goes into effect will be impossible. There are going to be many doctors and hospitals that refuse to treat new Medicare or Medicaid patients and those individuals are going to have to have great difficulty in finding anyone who will give them health care.
This is not just another bug in the system. The shortage of doctors is going to kill people. And it will be on the heads of Democrats and this president.