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OP-ED: Doctor shortage in Pennsylvania will

blunt health reform’s effect -by Steve Jacob T

he new health reform law is expected to create 32 million more insured Americans, according to the Congressional Budget Office. The federal government plans to expand Medicaid to low-income adults and subsidize purchases on the health-insurance exchanges when it requires most Americans to carry insurance in 2014. However, an insurance card will not mean much to patients without providers to care for them. Pennsylvania will have 808,000 more insured residents be- cause of reform, according to an Urban Institute analysis. A primary-care physician is the first contact for people with undiagnosed illnesses. They include family physicians, pediatricians and internal-medicine doctors. Primary-care physicians’ share of the U.S. health-care dollar is only 7 cents. However, primary-care doctors control 80 cents of the health-care dollar by sending their patients to hospitals, re- ferring them to specialists and handing out prescriptions. The U.S. has the about the same number of physicians per capita as other industrialized nations. However, the U.S. has far fewer primary-care physicians than specialists. They make up about 50 percent of the physician workforce in most other developed nations, compared with 35 percent in the U.S.

The number of U.S. specialists per capita has risen dramati- cally since 1965, while the ratio of primary-care physicians has remained relatively constant, because they earn as much as three times more income. The outlook is for more of the same: greater scarcity of primary care and a growing supply of specialists. Massachusetts reformed its state health-care system in 2006, giving the nation a glimpse of what is to come when access to health insurance is expanded without expanding the supply of primary care. The average wait for a non- urgent appointment with an internist rose from 17 days in 2005 to 48 days in 2011. Less than half of family physicians there are accepting new patients, compared with 70 percent four years ago.

Massachusetts has about 108 primary-care physicians for every 100,000 residents, compared with only about 85 per 100,000 in Pennsylvania. This ultimately suggests an even longer wait locally. The primary-care workload is expected to increase by nearly 30 percent between 2005 and 2025. A number of fac- tors feed this demand, including a growing population, a flood of baby boomers becoming Medicare beneficiaries and acquiring medical conditions as they age, and the newly insured because of the reform law. However, the supply of primary-care physicians is expected to rise by only 2 to 7 percent. Three out of 4 physicians say they already are at or over capacity. The math screams that there will be a crisis of health-care access in the next 15 years. Expect longer waits for appointments, shorter physi- cian visits, greater use of nonphysicians for routine care, and higher prices.

The U.S. trains about 16,000 doctors a year. The nation would have to increase that number by 6,000 to 8,000 annu- ally for 20 years to meet expected demand. Adding to the sense of urgency is the fact that about 1 out of 4 Pennsylvania physicians is age 60 or older. A bout 4 percent of Pennsylvania residents currently live in federally designated primary-care shortage areas. Physi- cians tend to cluster in areas where supply is already high rather than where the need is greatest. About 80 percent of new physicians in the 1980s and 1990s did this. They like affluent areas with well-insured patients, high-tech hospitals and civic amenities that offer a better quality of life. These high-income enclaves are also home to the nation’s healthi- est people.

Most do not want to recognize that health care is rationed. It is done so by lack of insurance. Health reform is expected to rectify that, but it will exacerbate a new form of rationing: the doctor is not in.

Steve Jacob is a veteran health-care journalist and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking.

Are Antibacterial Soaps Anti-Life? By Amy Mathews Amos


hen my sister and I were kids, we giggled upon learn- ing that 60 percent of the human body is comprised of

water. We wiggled and wobbled and moved our bodies in mushy wave-like motions, mimicking the sloshy mess one would expect of something made largely of liquid. It turns out we should have been pretending we were covered in bugs.

Scientific studies now reveal that nine out of 10 cells in our bodies are not actually us, they’re microbes. Yes, we’re crawling with microscopic creatures, including bacteria, viruses, and fungi.

And in fact, the overwhelming majority of these creatures

are not bad, but good. These puny partners, having evolved with us for eons, aren’t just hitching a ride. They’re earning their keep with hefty tasks – helping digest food, absorb nutrients, and attacking disease-causing invaders. So if they’re good, and we need them, then why are we working so hard to kill them? And by harming them, are we also unknowingly harming ourselves? Sales of antibacterial consumer products – including multiple brands of antibacterial hand soap, body soap, dishwashing liquid, sponges and more – have mushroomed recently, fed by our growing fears of germs and nasty “su- perbugs” that no longer respond to antibiotics. Up to 75 percent of hand soap now sold in the U.S. is antibacterial. I even bought antibacterial cotton swabs recently by mis- take, not noticing the antimicrobial claim until I got home. Which begs the question: do I really need to worry about microbes in healthy ears? In truth, most of these products aren’t needed. Washing hands with regular soap and warm water removes harmful germs just as effectively as antibacterial soap, says the U.S. Food and Drug Administration. Soap binds with bacteria, picks them up off the skin, and allows them to be whisked away with warm water. People with compromised immune systems from chronic disease or chemotherapy may want added protection, but most of us don’t need it. In fact, antimicrobial products may be bad for you. Most antibacterial items are treated with a pesticide called triclo- san. Studies suggest that triclosan disrupts thyroid and sex hormones in animals. It also gets washed down drains into waterways, where sunlight converts it into a poisonous di- oxin that hurts fish and wildlife. Also, remember that triclosan kills all bacteria, which means it can kill those good bugs on your body that help prevent disease by keeping harmful bacteria, viruses and fungi in check. Some scientists worry that excessive use of antibacterial soap could actually make infectious bacteria worse by accelerating their resistance to antibiotics. But it’s not just about infection. Many scientists believe good microbes play a critical role in regulating our metabo- lism, guiding brain development, influencing behavior and regulating health. For example, microbes in the gut have been shown to alter brain chemistry in mice, affecting anxi- ety and depression, and they may influence inflammatory responses that contribute to cancer and heart disease. The National Institute of Health is currently examining the trillions of microbes found in the human mouth, nose, esophagus, gut, skin and urogenital tract to identify which are found in healthy people, and which are missing in those who aren’t. Related research is exploring whether microbes can help treat chronic digestive and autoimmune disorders such as Crohn’s disease and multiple sclerosis. Scientists are also studying whether modern medical practices such as C-sections (in which newborns bypass healthy bacteria in the birth canal), and excessive antibiotic use are contributing to escalating health problems such as asthma, food allergies, and obesity. So save your creepy crawly fears for Halloween. Most of those trillions of tiny creatures on your body help maintain a very complicated and miraculous system: you. Wash the truly scary bugs away with simple soap and water and ignore the marketers trying to trick you into buying some- thing you don’t need. Your microbes, and the remaining 10 percent of human cells in your body, just may thank you.

Amy Mathews Amos is an independent environmental consul- tant and writer. © 2012.


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