title: Physician willingness and resources to serve more Medicaid patients: perspectives from primary care physicians.
abstract: OBJECTIVE
  Sixteen million people will gain Medicaid under health reform. This study compares primary  care physicians (PCPs) on reported acceptance of new Medicaid patients and practice characteristics.
  
  
  METHODS
  Sample of 1,460 PCPs in outpatient settings was drawn from a 2008 nationally representative survey of  physicians. PCPs were classified into four categories based on distribution of practice revenue from Medicaid and Medicare  and acceptance of new Medicaid patients. Fifteen in-depth telephone interviews supplemented analysis.
  
  
  RESULTS
  Most high- and moderate-share Medicaid PCPs report accepting "all" or "most" new Medicaid patients. High-share  Medicaid PCPs were more likely than others to work in hospital-based practices (20%) and health centers (18%). About 30%  of high- and moderate-share Medicaid PCPs worked in practices with a hospital ownership interest. Health IT use was  similar between these two groups and high-share Medicare PCPs, but more high- and moderate-share Medicaid PCPs provided  interpreters and non-physician staff for patient education. Over 40% of high- and moderate-share Medicaid PCPs reported  inadequate patient time as a major problem. Low- and no-share Medicaid PCPs practiced in higher-income areas than  high-share Medicaid PCPs. In interviews, difficulty arranging specialist care, reimbursement, and administrative hassles  emerged as reasons for limiting Medicaid patients.
  
  
  CONCLUSIONS
  PCPs already serving Medicaid are positioned to  expand capacity but also face constraints. Targeted efforts to increase their capacity could help. Acceptance of new  Medicaid patients under health reform will hinge on multiple factors, not payment alone. Trends toward hospital ownership  could increase practices' capacity and willingness to serve Medicaid.
authors.affiliation: Center for Studying Health System Change, Washington, DC 20024-2512, USA. asommers@hschange.org
authors.forename: Anna S
authors.initials: AS
authors.lastname: Sommers
authors.forename: Julia
authors.initials: J
authors.lastname: Paradise
authors.forename: Carolyn
authors.initials: C
authors.lastname: Miller
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D007407:Interviews as Topic; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States