The United States is facing a primary care provider shortage. By 2030, the projected shortage of Primary Care Physicians is expected to reach as high as 49,300, according to the Association of American Medical Colleges.
What can be done to address this looming crisis? Carson-Newman reached out to five health care professionals to get their perspective on what policymakers, politicians, and key stakeholders can do to improve access to primary care across the county.
Jack Springer, MD (CA)
"The answer to the primary physician shortage is multifaceted.
"First off, medical students must be incentivized educationally with more focus on the advantages, and financially with free education and/or “sponsorship” with a required time commitment. This happens to some extent when towns pay for Med school for students who commit to practicing there for a period of time upon graduation.
"Ultimately, most of primary care need not be done by doctors. Training legions of mid-level providers such as Physician Assistants and Nurse Practitioners would go a long way towards meeting needs. This would decrease the cost, increase access, and create thousands of jobs. For patients with more complicated health care needs, primary care would be overseen by a physician.
"Artificial Intelligence is a critical component to more accessible, complete and affordable health care in the U.S. There is no reason why people shouldn’t be able to have their blood pressure checked for free (by a machine) while shopping at Walmart. They could receive alerts after being found to meet criteria for needing blood pressure medication. After entering demographic and health information electronically, the best medication to meet their needs could automatically be prescribed and dispensed by the pharmacy. The patients would all be required to set up a physical exam and have basic blood work done within a month of prescription. This could also be done (e.g., at Walmart) by mid-level providers.
"The costs for the services listed above would be minimal and should be free for those that can’t afford them. Many cases of diabetes could also be initially managed this way, and then continually after appropriate initial medical work up.
"For routine primary care such as aches/pains/coughs/colds, patients should turn to mid-level run clinics in pharmacies, stores and urgent care clinics. Often Emergency Room visits and their cost and stress could be avoided altogether.
"The American health care crisis is solvable!"
Jeffrey Barke, MD (CA)
"As the field of medicine has become more and more regulated we have seen a dramatic decline in the number of medical school graduates choosing primary care residencies. Compound this with current Primary Care Physicians retiring earlier and many transitioning to concierge practices, and you get a critical shortage of Primary Care Physicians.
"So what’s the solution? The typical government solution will be to use government regulations and incentives to encourage more medical students to choose primary care – this will have limited success. A better approach is to make primary care more attractive and lucrative again by doing the following:
- Reform malpractice insurance to a British “loser pays” system to reduce frivolous actions.
- Create a National Medical License reciprocity system for Primary Care Physicians to make it easier for physicians to move from state to state.
- Adjust Medicare (and the other payers will follow) reimbursement upward for primary care services.
- Allow Primary Care Physicians to deduct the cost of providing charity care.
- Reduce the federal tax rate for income earned for Primary Care Physician services."
Corinthia Loblack, MSN, NP, Certified Health Coach (FL)
"Nurse Practitioners and patient empowerment are the gateway to solving the looming shortage of Primary Care Physicians.
"All states should allow Nurse Practitioners to function to the full extent of their training and competencies. Talking about comparable training between a Primary Care Physician and a Nurse Practitioner, Nurse Practitioners enter the medical field with patient care experience that the medical student lacks. Nurses are taught to treat patients more holistically rather than just as a symptom.
"I began my nursing career in a teaching hospital and viewed how dependent residents were on nursing judgement and expertise during their first six months of their training. Nurse Practitioners are able to advocate for and help patients take charge of their health.
"Nurse Practitioners are graduating from programs at a rate that would fill the gaps left by the decrease in Primary Care Physicians. Nurse Practitioners’ patient care has been found to be at par if not better than physicians in treating, diagnosing and patient outcomes.
"The use of a collaborating physician in states that mandate it is, in my opinion, a way to increase physicians’ income and in no way is shown to improve patient care. Many standalone primary care clinics are run by Nurse Practitioners. The VA has given Nurse Practitioners full autonomy* and it’s time that states stop talking about the shortage of Primary Care Physicians and do something about it – allow Nurse Practitioners function to the full extent of their training."
*Editor’s Note: In 2016 the United States Department of Veterans Affairs granted veterans direct access to primary care by a Nurse Practitioner and gave Nurse Practitioners full autonomy by authorizing them to practice to the top of their education and preparation, without physician supervision, in all areas of practice with the exception of prescribing controlled drugs.
Gerianne Hap, Pharmacist, MBA, Health Policy Consultant (IN)
"There are many actions we can take in order to help alleviate the shortage of Primary Care Physicians, but we are also facing shortages of physician specialists. Here are a couple of ideas that may help.
"Much of the care provided by Primary Care Physicians can be provided by Nurse Practitioners and Physician Assistants, at a lower cost. By using them to the fullest extent of their scope of practice, we can free up MD time to manage difficult or complex cases and channel more MDs into specialty practices. We need to increase the number of Physician Assistants and Nurse Practitioners by adding programs and increasing the number of students accepted into these programs. We can add these professionals to the system more quickly, within 6-8 years, rather than the 9-15 years needed for MDs. Perhaps medicine can learn from the legal profession where the Partner (MD) supervises the associate and paralegal (NP, PA) team members.
"I would also recommend expanding the scope of practice for pharmacists to include management of chronic diseases such as hypertension and diabetes, along with the appropriate reimbursement. A good example of this is pharmacist management of coumadin clinics. There are also a number of drugs that can be moved from prescription only to pharmacist dispensing."
Siobhan Bulfin, founder of Melon Health (CA)
"With a current Primary Care Physician shortage and chronic disease pandemic, new models of care are needed to reduce the burden on Primary Care Physicians, the bulk of whose time is spent seeing patients with non-acute chronic conditions such as pre-diabetes and other metabolic disorders.
"The answer lies in leveraging a non-clinical workforce for lifestyle interventions and supported self-management, thereby freeing up nurses and physicians’ time who can then focus on patients with more acute needs.
"Digital platforms are key enablers in this model, particularly for rural populations who suffer from distance decay and other social determinants that make going to the clinic a barrier to them getting well."
What are your thoughts about the Primary Care Provider shortage? Please comment on how you would tackle the problem below!
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