Solving the nation's primary care shortage
The supply of primary care physicians needed to bolster the move toward quality-driven reimbursement models is becoming increasingly stretched. And as the emphasis on prevention and chronic disease management increases, more strain will come.
By 2025, the country will require as many as 35,600 more primary care doctors, and as many as 94,700 physicians overall, to meet the increasing demand of a growing and aging population, according to data released by the Association of American Medical Colleges (AAMC) earlier this year.
The projected shortage might have a benefit for primary care doctors, with salaries already on the upswing. But it’s still uncertain to what extent, if any, team-based care and the training of other clinicians will offset the burden for physicians faced with overflowing waiting rooms.
Moreover, the shortage will occur just as accountable care organizations, readmission penalties and other changes in practice design and reimbursement place a premium on better care coordination and other steps to keep patients out of the hospital, says Clese Erikson, deputy director of the George Washington Health Workforce Research Center in Washington, DC.
“There’s been a lot of effort to study the impacts on quality and costs,” she says. “But very little explicitly looking at the demand for physician services.”
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To ease the pressures on physicians, health systems and large practices are taking steps such as hiring more non-physician practitioners and emphasizing broader, team-based care, say Erikson and other researchers studying issues related to physician supply and demand. Improvements in technology, they hope, also will play a role. But whether those efforts will expand the number of patients each doctor’s practice can treat is still unclear.
Meanwhile, the projected shortage must be tackled on several fronts, starting with increased federal funding for residency slots, says Janis Orlowski, MD, chief healthcare officer at the AAMC. To meet the looming primary care demand, the reality and the perception of the career path also will need a makeover, says Orlowski, citing feedback from medical students that it’s not “a fulfilling” work life.
“What they see is primary care doctors, who in order to make a good living and/or pushed by other productive measures, are not spending time and attention in providing care to a patient,” she says.
Boosting the supply
While some of the projected demand for both primary care doctors and subspecialists can be traced to expanded coverage under the Affordable Care Act, the main drivers are the nation’s aging demographic profile, along with anticipated retirements by physicians, according to the AAMC.
Within the next decade, the number of adults age 65 and older will increase by 41% compared with 5% for the population under age 18. The doctors needed to treat them also are aging. By 2025, slightly more than one-third of doctors currently working will be 65 or older, according to the AAMC.
But the number of federally-funded residency training slots has been frozen since the late 1990s and thus has not kept pace with those trends, Orlowski says. And while Congress has proposed legislation to boost the number of residency slots by 15,000 over five years, more physician residents does not necessarily translate to more primary care providers, research indicates.