New Primary Care Models Could Help Physician Shortage

With increasing numbers of Americans gaining insurance under the Affordable Care Act, many experts are worried about the looming physician shortage.

With increasing numbers of Americans gaining insurance under the Affordable Care Act, many experts are worried about the looming physician shortage. Some have advocated for the federal support of financing graduate medical school programs to train additional doctors, while others are promoting the use of support staff such as nurse practitioners to fill the physician demand. The Association of American Medical Colleges estimates that the physician shortage will be 92,000 by 2020, and 130,600 by 2025, if not addressed immediately. However, new thinking suggests that changes to care delivery models could ease the need for more physicians.

“Projections suggest that if nothing changes in the delivery of primary care, the United States may face a substantial shortage of primary care physicians and surpluses of nurse practitioners and physician assistants by 2025,” said researchers at the RAND corporation. “Yet plausible shifts in primary care delivery models substantially affect those projections. Increases in diffusion of the medical home and of the nurse-managed health center would both work to reduce demand for physicians.”

Dr Scott Shipman, AAMC director of primary-care affairs, said that if physicians reassigned 30 minutes of their daily clerical tasks to a non-physician in their office and spent that time with 1 patient, it would make possible between 30 million and 40 million more physician visits a year. Models like the patient-centered medical-home (PCMH) and accountable care organization are both utilizing such initiatives, ensuring that work is assigned appropriately to employees.

Retail clinics are also being used as supplementary providers to primary physicians. Retail clinics are not only more convenient for many consumers, but they tend to be cheaper than private physicians’ offices and hospital-based care. A 14-day episode for the 10 most common diagnoses in a retail clinic averages about $500, while the same procedure could cost around $700 from a physician. CVS Caremark alone expects to have 1500 MinuteClinics by 2017.

“Our expansion of services earlier this year is helping patients get the right care at the right time, in a convenient and affordable setting, from our nurse practitioners and physician assistants,” said a spokesperson for Walgreens, which is also expanding. “The additional patients gaining insurance coverage as a result of the Affordable Care Act are one of the factors for this service expansion and our plan to open more Healthcare Clinics in our existing markets. We believe this will help meet the significant health care access needs in the communities we serve.”

Expanding the laws regarding who can perform care delivery functions will be key to avoiding the projected physician shortage.

Around the Web

What Doctor Shortage? [Modern Healthcare]

Doctor Shortage Could Ease As Obamacare Boosts Nurses, Physician Assistants [Forbes]