As we move towards the full implementation of the ACA, primary care is being positioned as the foundation of our healthcare system, and rightly so. Numerous studies show that communities and health systems with a solid primary care foundation experience lower mortality rates, better outcomes fewer hospitalizations and lower overall healthcare costs. This has been attributed to the greater use of preventative health care, treating health problems at earlier stages and the increased potential for care coordination.
As of August 2012, The Health Resources and Services Administration has designated 5,721 primary care Health Professional Shortage Areas (HPSA) encompassing a population of 54.4 million people and requiring a total of 15,162 practitioners to meet their need for primary care providers. Some estimates predict that by 2015 there will be a shortage of 35,000 primary care providers in the US health system. Already, the current lack of primary care providers is widely believed to be a contributor to the fragmentation of care and inefficiency in the health system. Less accessibility promotes the inappropriate utilization of specialists and emergency rooms and drives the overall cost of care even higher.
Supply & Demand
By creating new care delivery models (Accountable Care Organizations, Patient Centered Medical Homes) and expanding coverage to more than 30 million Americans by 2019, primary care will be at the forefront of health care reform initiatives. This expansion of coverage combined with a rapidly ageing baby boomer generation equates to a demand for primary care doctors that is higher than ever.
The supply side of the equation is truly worrisome. As working primary care physicians retire, fewer medical students are choosing to practice primary care with many instead opting to train and practice in specialty medicine. Only 16% to 18% of medical students in 2010 were likely to practice primary care, according to the New England Journal of Medicine. Poor reimbursements, low comparative income and an undesirable work/life balance due to increasingly high patient loads are all cited as contributors to this lack of interest in primary care among medical students. In addition to this, economic and regulatory challenges are sending many primary care doctors out of the medical profession and older physicians into early retirement. Declined reimbursements, high overhead, increasing administrative burden and other complexities are all contributing to this trend.
There will not be a quick and easy solution to the primary care shortage or a solution that is feasible for all primary care providers and patient populations. Being that increased funding and other incentives to encourage the training of new primary care physicians will take a long time to impact the system, a combination of other approaches are necessary to help alleviate the primary care shortage. Below we highlight some of these approaches:
- Expand the role of nurse practitioners to deliver routine primary care services.
- Developing and expanding programs that eliminate student debt for graduates and provide incentives for physicians to remain in under-served areas.
- Continued investment in new practice models such as Direct Primary Care that reduce administrative burden and encourage direct financial relationships between patients and providers.
- Implementation of payment reforms including bundled payments for patient populations over a defined period of time and pay for performance to improve coordination and provide stability to provider reimbursements.
- Implement policies that encourage the immigration of primary care physicians. Foreign-born doctors are already a major component of the primary care workforce, but in recent years the US has become less welcoming.
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