Back in October, the the American Journal of Medical Quality published a warning that, even as Medicaid is expected to vastly expand the patients it serves across the country under the requirements of the Affordable Care Act, the doctors willing and able to serve those patients are already at capacity. Now, California officials are getting hip to the fact that the state doesn't have enough physicians to go around, and they're scrambling to find pretty much anybody capable of bandaging a boo boo to fill the gap.

From the Los Angeles Times:

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. ...

Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges.

State officials' first instinct isn't unreasonable: To ease occupational licensing barriers so that other health-care providers can do more to deal with the shortage.

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.

Arizona already lets nurse practioners hang their own shingles, and the sky has yet to fall. These practioners are usually perfectly able to deal with the usual issues seen at the primary care level, and then to pass concerns beyond their abilities higher up the food chain — which is what primary care physicians do, anyway.

But the LA Times article also cautions that letting alternative practioners fill the gap "could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics." I'll add that alternative practitioners also tend to see fewer patients than physicians. Pediatric nurse practioners see, on average, 11-20 patients per day, which is about half what physicians see.

Which is no reason not to free these providers to see patients. That should be done to provide choice and competition, independent of the demands of Obamacare.

But, are those nurse practitioners and pharmacists going to be any happier than physicians with expanded Medicaid?

Last year, a Physicians Foundation survey found that 26 percent of physicians had closed their practices to Medicaid patients because of concerns over compensation and red tape. Kaiser says the number of doctors turning away Medicaid patients is closer to a third.  Pharmacists haven't been much happier. Walgreens pharmacies in Washington turned away Medicaid prescriptions because they were losing money filling them (the state relented) and pharmacies did the same in Delaware.

Expanding the pool of potential health care providers is a great idea. But, believe it or not, physician assistants, nurse practitioners, optometrists and pharmacists expect to be paid, too. If they get frustrated and lose money the same way physicians have, there will just be a larger pool of people refusing Medicaid patients.