Coloradans could have trouble finding primary care doctors due to increasing demand for their services.

(Photo: Courtesy Flickr user Vic)
A lot of the discussion about the Affordable Care Act, or Obamacare, has focused on people getting or losing their insurance coverage.

But having insurance doesn’t guarantee Coloradans will get health care.

"We actually have a number of people who are waiting to get into our practice," Dr. Paul Melinkovich, director of ambulatory care at Denver Health, says. "In order to provide what would be a reasonable quality of care to the patients, we can’t take everybody who wants to get in."

Melinkovich adds that about 9,000 people are waiting to get access to a regular family physician at his facilities and the demand is only going up with more people getting insurance through Medicaid and the state's health exchange.

Still, Denver Health hopes it will be able to eliminate the waiting list this year by adding more doctors to the staff. 

But Melinkovich says that while he's optimistic, he's not sure Denver Health will be able to meet the increasing need for primary care.

"It has a lot to do with how much unmet demand is out in the community, which is really hard to gauge," Melinkovich says. "I suspect there are people in the community who, once they get Medicaid or once they get on the exchange, they’re going to want care." 

According to Melinkovich, that’s what happened in Massachusetts when the state decided to expand its program to do universal health insurance: all of a sudden there was more demand than they could meet.

"We expand that’ll happen for while as well," Melinkovich adds.

Melinkovich also points out that Denver Health doesn't keep children or pregnant adults on a waiting list, something that also true elsewhere in the state.  

Accoridng to a recent survey by the Colorado Coalition for the Medically Underserved of people living in affordable housing, adults tend to face long delays for primary care services while children were usually able to secure timely appointments.

Now, a national association of primary care doctors is sounding the alarm bell.

The group says to meet demand from more people with insurance and the state’s aging population, Colorado needs to increase by 50 percent the number of primary care doctors it’s on track to have by 2030.

The chair of the board of the American Academy of Family Physicians is Denver physician Jeffrey Cain, who tells Colorado Matters host Ryan Warner that giving more people insurance without assuring there will be enough doctors to treat them is like "giving everybody a bus ticket and not having enough buses."

Cain is calling for changes to how the federal government funds medical residencies, saying there needs to be more coordination between the needs of the population and the number of students going into primary care as a specialty.

The needs are particularly great in Colorado's rural areas and in underserved, dense urban areas, according to Cain. 

In rural areas, retirements of existing primary care doctors are the biggest concern.

In some parts of the state, one physician serves several small communities.

And Cain says that it can be hard to get young doctors to set up a practice those places but is encouraged by pilot programs, funded by the Affordable Care Act, that are encouraging medical students to train in rural Colorado.

But Cain points to neighboring Kansas, where the state offers loan forgiveness for new doctors who choose to practice in underserved communities, as an example he'd like to see the state follow in the future.

Some of the concern nationally is around the Medicaid expansion.

Historically, some physicians have declined to take on some Medicaid patients because reimbursements from Medicaid can fall below what doctors receive from private insurers.

Under the Afforadable Care Act, doctors will get higher reimbursements from Medicaid for two years as a way to encourage them to take on more Medicaid patients. Colorado is participating in this program.

The American Academy of Family Physicians' analysis comes two years after a comprehensive report by the Colorado Health Institute, which predicted Colorado would need an additional 83 to 141 primary care providers, including between 71 and 117 additional physicians and between 12 and 24 additional nurse practitioners and physician assistants by 2016 because of the expansion of health insurance in the state.