Imagine the government ordering millions of new customers to buy from your industry — and giving them money to make purchases.
Now imagine that the government won't tell you how many new customers you'll have, how you'll get paid and that you might get paid less if you don't change the way you do business.
Welcome to the world of America's family doctors in the emerging age of Obamacare.
With the main provisions of the Affordable Care Act — the most sweeping changes in the nation's health care system since the passage of Medicare in 1965 — taking effect in just under five months, family physicians are sweating out the slow rollout of the law's regulations. Despite the guarantee of plenty of new patients, physicians hold mixed feelings about Obamacare.
They're feeling frustration about significant unknowns, including the insurance to be offered on the Obamacare exchange in Pennsylvania. For many, the frustration started earlier, as a separate but related law pushing health care providers to use electronic medical records cost them time and money.
But physicians also are hopeful that previously uninsured people will soon have the opportunity to improve their health and pay for their care.
In short, it's a period of transition for a profession that some members admit does not deal well with change or loss of power.
"They're pretty stressed out that all this structure has been imposed on them," Sacred Heart Hospital CEO John Nespoli said.
At the top of Obamacare's priorities is to provide health insurance for 23 million uninsured Americans by 2016. They'll be able to shop beginning Oct. 1 for coverage that takes effect Jan. 1. For doctors, that leads to an obvious question: Will there be enough of them to take care of all those newly insured patients?
Residents in remote rural areas, where primary care already is in short supply, likely will see the supply-and-demand crunch worsen. But in the Lehigh Valley, physicians believe they'll be able to handle it.
"One of the biggest pieces of the Affordable Care Act is the potential of floodgates opening up," said Dr. Eric Gertner, a primary care physician at Lehigh Valley Health Network. "I think that's probably an overstatement. … I think we have the capacity to absorb them at the rate at which they'll begin to seek care."
That's backed up by a survey done earlier this year between the Pennsylvania Association of Family Physicians and Franklin & Marshall College pollster G. Terry Madonna, which found that 90 percent of family practices said they were accepting new patients.
The front line of health care is known as primary care and it includes physicians such as family medicine and internal medicine doctors, pediatricians and gynecologists and their staffs. They're the ones who will manage the first waves of newly insured.
One of the ways they're planning to cope is by adding primary care doctors like Dr. Darshan Patel, who opened a Sacred Heart Hospital family practice in South Whitehall Township last year. Sacred Heart has doubled its primary care physician roster in the past three years and plans to continue adding to it, Nespoli said.
At St. Luke's University Health Network, Dr. Michael Abgott, chief of family medicine, said the network is hoping to hire more than 20 primary care doctors this year. Medicare reimbursements for primary care, which were low compared to specialty care services, have increased, so the pool of primary care providers should improve, Abgott said.
Still, new primary care doctors are in short supply, so practices such as George M. Joseph Associates in Lower Nazareth Township are filling the gap by hiring nurse practitioners, nurses who are more intensively trained and can do tasks once reserved for physicians — examine patients, write prescriptions and order lab tests.
"We will likely be doing more of that as we look for more internists," said Dr. Mark Koshar, one of seven physicians in the practice.
Health professionals like nurse practitioners become more important as Obamacare nudges providers toward models that provide more coordinated care, such as the patient-centered medical home. In that model, the physician directs a team of nurses, case managers and other physicians to provide care, so the patient might see less of the family doctor but get more complete services when they're at the office. For instance, a patient who seeks treatment for a tick bite also might get a routine cholesterol test and schedule a colonoscopy all in the same visit, Patel said.
Patel came to the Lehigh Valley after working at a Geisinger Health System community practice site in Mountainhome, Monroe County, that used the medical home model. He said that by working with nutritionists, nurses and physical therapists, doctors were able to improve patients' health while reducing hospital admissions.