The Patient Protection and Affordable Care Act included measures to boost the primary-care workforce, but according to a new report, more needs to be done to address looming shortages in the near future—such as relaxing scope-of-practice laws and enacting payment reforms.
Reform pay, scope of practice to address workforce shortage: report
The National Institute for Health Care Reform's report, Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage (PDF), notes that some 300,000 physicians, 80,000 advanced-practice nurses and 20,000 physician assistants are providing primary healthcare services in the U.S. today, but that it's believed that 25,000 to 45,000 more doctors will be needed by 2020 as the nation's elderly population increases. The report was written by researchers at the Center for Studying Health System Change.
Although the healthcare reform law contained provisions for boosting the primary-care provider ranks, according to the report, the gains realized by those provisions may be too small to significantly increase the workforce.
According to the report, about 3,000 new primary-care physicians now enter the workforce annually, but this is not a net gain as it doesn't take into account the doctors who no longer practice. The reform law offers some financial incentives—such as medical student-loan forgiveness and short-term Medicare and Medicaid payment increases—but the researchers said that predicting this would result in increasing the primary-care workforce by 600 more doctors a year would be "an optimistic assumption."
The authors wrote that these efforts "could be bolstered by complementary approaches" such as expanding scope-of-practice roles for APNs and PAs and enacting payment reforms that would enhance the productivity of the primary-care workforce (such as incentivizing team-based care).
According to the report, 22 states and the District of Columbia allow APNs to practice independently and that two-thirds of the states that are experiencing shortages of primary-care physicians have "restrictive" scope-of-practice laws.
The authors cite studies that raise a concern about team-based models of care such as the patient-centered medical home. According to the report, practices that operate as medical homes often have smaller patient panels, so growth in the model may mean that more physicians will be needed as doctors will consequently be seeing fewer patients. Conversely, the authors wrote that evidence suggests that physicians practicing under the medical-home model have more professional satisfaction and this may drive more medical residents toward taking a primary-care career path.
"In the current fiscal environment, increasing primary-care compensation relative to specialists to levels that have successfully changed the population of practitioners in other nations is unlikely," the authors concluded. "In addition, unquantifiable factors, such as culture, status and professional identity may play as great a role as payment in determining where and how clinicians provide care."
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