Those who forecast shortages of primary-care physicians may be shortsighted, a group of academic researchers says in a Health Affairs report likely to stir controversy on a much-debated issue.
The hand-wringing about primary-care shortages is unwarranted if those making the predictions are basing their estimates on doctor-to-general-population ratios that don't align with the productivity of a modern physician practice, researchers from the Columbia Business School in New York and the University of Pennsylvania's Wharton School in Philadelphia said.
They also argued that shortages could be averted with physician "pooling," effective use of nurse practitioners and physician assistants and technology that reduces the need for face-to-face visits. In their report
, the researchers wrote that using ratios—such as one primary-care doctor for every 2,500 people—to project shortages assumes the traditional model of patients being seen by a single physician is still the order of the day, which leads to misdirected conclusions.
The researchers argued that a practice's patient panel can be expanded by using "open" or same-day scheduling, which calls for giving patients the option of seeing another doctor if their regular physician is unavailable. This model calls for creating "pods" of two or three doctors supported by a nonphysician professional and the use of a common electronic health-record system.
"Furthermore, if we include the impact of diverting a fraction of patient appointments to nonphysician professionals or of addressing some of the demand through electronic communication channels, the predicted physician shortage essentially evaporates," the authors wrote, citing a 2009 Kaiser Permanente study
that found that primary-care visits decreased 25.3% after implementation of an EHR that encouraged electronic communication with patients—rather than in-person visits—pertaining to management of chronic conditions.
Projected shortages, they argued, are based on single-physician practices facing an increased number of patients demanding an increased volume of services. But through pooling and diversion, "this projected shortage can be completely eliminated," they wrote.
Physician pooling and diverting patients to nurse practitioners and physician assistants could lead to a loss of continuity, the authors acknowledged. But the loss of continuity would be greater if patients chose instead to go to a hospital emergency room for primary-care services.
Given the current trends toward team-based care and EHR adoption, the authors concluded that "the widely perceived national primary-care physician shortage that has been forecast may, in fact, be greatly overestimated."