State of the Industry: Primary care physician shortage

According to the Association of American Medical Colleges, the United States will face a shortage of 130,000 physicians by 2025, with primary care accounting for the largest share (37%).

A majority of MHE readers say the shortage is understated (66.5%), while others say it’s overstated (21.4%), being addressed well enough (6.8%) or they don’t know (5.3%).

“It’s a real issue,” says Bob Williams, national medical leader of healthcare consulting practice Deloitte LLP. “We’re suffering not only from a reduction in recruitment of primary care specialties, but also the aging out of a generation of residency-trained primary care physicians.”

Although more than half of medical students indicate an interest in primary care when first starting out, only 20% stick with it by year three of medical school. Significant income gaps and reimbursement systems are often blamed. As systems began rewarding volume over value, the dynamic caused physicians to seek more patient visits in order to remain profitable.

In the last few years, Williams says, there has been an increase in recruitment but not enough to make a significant impact. The Department of Health and Human Services estimates the national physician supply with increase by only 7% in the next 10 years.

“There are fewer and fewer family practitioners out there who are really trained in primary care. I think we’re going to have an imbalance for quite some time,” says Bill Copeland, vice chairman, U.S. life sciences and healthcare leader and U.S. health plans leader, Deloitte LLP.

An additional 8,000 PCPs will be needed in 2025 to treat patients obtaining coverage under health reform as primary care visits are predicted to rise as high as 565 million annually, according to a study in the Annals of Family Medicine (November/December 2012).

“There will be an increased access issue with increased coverage, at least for awhile,” Williams says. “That also impacts being able to effectively assist in the management of chronic diseases in the outpatient setting. So, it’s challenging to try to move to the goals we’re all trying to move toward.”

Williams says health systems still have significant gaps when it comes to covering existing populations, and it’s important that they engage PCPs in emerging new priorities.

“As they experiment with increased clinical integration and increased assumption of risk by providers, there’s a significant need for primary care physicians to participate in that and for programs that are really going to address avoidance of readmissions to hospitals,” he says.

Medicaid managed care and Medicaid fee-for-service have the most severe shortages of primary care physicians because rates are the lowest, Copeland says, making it hard for physicians to build a robust practice that has a significant Medicaid population.

For example, some exchange health plans for lower-income populations are struggling to secure enough PCPs for their networks in certain locations, he says. Although not exactly a rate issue per se-exchanges will offer commercial rates-there’s a concern about building broad networks across a geography.

“Health plans are hoping this creates somewhat of a push around innovation to get mid-levels much more involved and an opportunity for broader acceptance of mid-levels in primary care,” Copeland says. “This is an opportunity to seize the day and see if there can be a way to get mid-levels more involved.”

It’s supply and demand, he says, as well as the price that results from it. Plans might pay a premium for access into the networks they need, especially for busy practices that take care of Medicare patients and their families.

“There have been some trends focused on skills related to patient-centered medical homes and programs to try to improve the operating efficiency of smaller practices,” says Williams. “Because they’re small businesses, it’s hard to do that-to help physicians be more efficient in the delivery of care and to learn some of those new skills.”

A near-term issue concerns the existing workforce of primary care providers, he says. Plans must figure out how to take advantage of and identify practitioners who can be part of a high-value network, and to find creative ways to engage, support and give them tools to do a better job.

“It’s two separate problems,” he says. “In the near-term and long-term, health plans might be able to help primary care physicians with tools-technology tools to do better care coordination-to deliver skills and help to advance skills in population health. That’s something that not only will help in the near-term, but if they’re successful, they will help recruit future physicians into that practice, because it will be more desirable.”