Many agree that in order to develop an efficient and effective healthcare system a strong primary care foundation is necessary. As evidenced in health systems around the world and in emerging care delivery models in the US, greater access and focus on primary care is associated with lower mortality rates, fewer hospitalizations and reduction of overall healthcare costs. The main goal of healthcare reform is to expand coverage and thereby access to medical care. Of key importance to this goal is the repositioning of primary care at the core of the healthcare system.
However, the US is currently experiencing a shortage of primary care physicians and the problem may get worse. Primary care is caught between a growing demand for services and a shrinking pool of providers. According to the Physician’s Foundation comprehensive survey, if current primary care trends continue more than 50% of physicians will cut back on the number of patients seen, work part-time, switch to concierge medicine, retire or take other steps that will reduce patient access in the next 1 to 3 years. In a previous post, ‘Highlighting the Challenge: The Primary Care Shortage in the US Health System’, we focus on the causes behind the primary care shortage and how health reform depends on primary care to serve as the foundation of many reform initiatives. Some key causes behind the primary care shortage are a lack of medical students willing to practice primary care; poor or declined reimbursements, high overhead, increasing administrative burden, lower income in comparison to specialists, and a more strenuous work/life balance. Below are 3 possible solutions to help alleviate the primary care shortage.
Possible Solutions to Ease the Primary Care Shortage
- Expand the role of nurse practitioners (NPs) and physicians assistants (PAs) to deliver routine primary care services.
State Legislators should take steps to expand the roles of nurse practitioners and physician’s assistants in the medical setting. Allowing them to provide care and routine treatments to patients without supervision of a physician would lessen the effects of the physician shortage and make patient loads more manageable. Research shows that care provided by nurse practitioners and physician assistants is comparable and even superior in some cases to the routine care provided by physicians. Well developed best practices and care guidelines are essential in moving forward with this initiative.
- Implement policies that encourage the immigration of primary care physicians.
There are simply not enough primary care physicians to meet needs of the US healthcare system and it will take many years for newly trained physicians to enter the workforce. Therefore, it only makes sense to encourage the best and brightest physicians from around the world to practice in the US. Foreign doctors currently make up approximately 27.3% of the physician workforce and already play an important role in the US primary care industry.
- Transitioning away from Fee-For-Service payment towards payment models that reward quality and care coordination.
Our fee-for-service payment system inadvertently rewards quantity of care instead of quality. Most experts agree that in order for primary care to be truly effective and efficient it is imperative to reward high quality care rather than simply the volume of services provided. Some of these payment reforms are the key enablers of emerging care delivery models such as patient centered medical homes (PCMH) and accountable care organizations (ACO). Options include:
- Global service payments where physicians are paid a lump sum to cover a pre-defined population of patients can help to provide financial stability and allow investments in EMR and staff. This has the potential to allow better management of patient loads and improve care for all patients.
- Bundled payments for specific treatments or medical conditions may also provide stability as well as reduce the administrative burden faced by primary care practices.
- Pay-for-performance initiatives that reward providers for helping patients achieve positive health outcomes address provider financial concerns as well as care quality issues.