Filling the Primary Care Gap

It is not a secret that the United States is experiencing an unprecedented shortage of physicians in internal and family medicine. According to the Annals of Family Medicine, there are currently almost 210,000 primary care physicians or about 30% of all physicians.  There is currently a shortage of 16,000 primary care doctors and by 2025, it is predicted that almost 52,000 additional primary care physicians will be needed to serve the growing and aging American population.

This looming public health crisis was one of the key reasons for the recently passed Affordable Care Act which not only addressed the shortage of primary care physicians but the sharp imbalance between urban and rural healthcare organizations.  The National Rural Health Association reports that only ten percent of physicians practice in lower population areas, despite almost a quarter of the U.S. population residing in these rural jurisdictions. The ACA seeks to reverse this gap by strengthening financial incentives like scholarships and loan repayment options for physicians to serve in these areas.

Despite an array of strategies like increased Medicare payments, primary care is likely to remain a less popular choice among medical students because of the growing caseload and a diminished income compared to other specialties.  To encourage more physicians to remain in this field, the ACA supports the consolidation of clinics to help make "one stop shops" for patients, and greater responsibilities for Advanced Practice Providers.

The ACA also increases funding for the education of Advanced Practice Providers like nurses, nurse-practitioners and physician assistants.  These highly trained medical professionals can provide many of the same services that primary care physicians like diagnostics, prescriptions, and patient education but at a reduced cost.  In many states APP's are legally authorized to perform most of the primary care duties with only limited supervision from the physician.

Another potential group that could help alleviate some of the need for primary care specialists are foreign trained M.D.'s.  These physicians who complete their medical training abroad and fulfill licensure requirements in the U.S. are often more willing to practice in rural areas.  According to Family Medicine almost 19.3% of rural primary care physicians in 2012 obtained their medical degrees abroad. These foreign trained physicians currently comprise a quarter of physician workforce in the U.S. In a recent study led by John J. Norcini, it was found that these international physicians were often more willing to go into primary care, and they were more likely to have better patient outcomes. The researchers postulated that those foreign trained physicians who enter the U.S. to practice are typically among the brightest in their native countries.

The Affordable Care Act has increased health insurance access to millions of previously uncovered Americans, but it has yet to supply the needed primary care physicians who can examine and treat many of the newly insured. Another complication is that many of these patients acquire coverage through expanded state Medicaid programs.  Through 2014, physicians treating Medicaid patents enjoy a bump in payments, but once these augmented payments end, many physicians may start to refuse to take Medicaid patients. This loss of income for many small business clinics may also divert many potential primary care practitioners into more lucrative or financially secure employment options.

There are many contributing factors to the primary care physician shortage, but there are potential solutions.  While federal legislation is both a boon and a burden to primary care practitioners, there is little doubt that without major changes, this problem will burgeon into a major health crisis in the next few years.  It will require cooperation and courage at the public policy, education and industry levels to stave off a devastating healthcare catastrophe which could hobble the medical professions for decades to come.  

Article written by:

Robert Moghim, M.D.

CEO, Health Carousel Locum Tenens