Supply won't meet growing demand for primary care

Supply won't meet growing demand for primary care

Kaitlyn Krasselt and Jayne O'Donnell, USA TODAY   June 30, 2014

Federally funded programs will add at least 2,300 new primary care practitioners by the end of 2015, but the funding for at least one of those programs is set to expire at the same time, contributing to a massive shortage of doctors available to treat patients — including those newly insured through the Affordable Care Act and Medicare.

The U.S. is expected to need 52,000 more primary care physicians by 2025, according to a study by the Robert Graham Center, which does family medicine policy research. But funding for teaching hospitals that could train thousands more of these doctors expires in late 2015.

Population growth will drive most of the need for family care doctors, accounting for 33,000 additional physicians, the study says. The aging population will require about 10,000 more. The Affordable Care Act is expected to increase the number of family doctors needed by more than 8,000, the study says.

Farzan Bharucha, a health care strategist with consulting firm Kurt Salmon, says the ACA should have focused more on the primary care shortage "because we already knew there was a problem -- and we knew implementation of ACA would potentially make it worse."

Health and Human Services spokeswoman Erin Shields Britt says continuing to build the primary care workforce will take time, but she notes President Obama's budget working its way through Congress has several new ways to expand the primary care workforce, which includes nurse practitioners and pediatricians. The ACA, she says, significantly increases the number of primary care providers in underserved areas and increases Medicare and Medicaid payment for services delivered by primary care practitioners.

ACA funding that added 600 new primary care residencies was part of a five-year investment that expires at the end of 2015, eliminating the chance to produce hundreds more doctors each year.

But many agree far more needs to be done. Among the issues:

• Other medical residency funding. More oversight is needed in the distribution of the current $12 billion in federal graduate medical education (GME) funding, which is used for medical residencies, says Bob Phillips with the American Board of Family Medicine. Hospitals can decide the kind of residencies to create and tend to train and hire specialists who bring in more revenue than primary care doctors, he says. HHS says reform is needed, but that it doesn't have authority to make program changes since the GME formula is determined by Congress.

• Rising cost of medical school. For the class of 1992, the median education debt was $50,000. In 2012, it was $170,000, according to a 2012 Association of American Medical Colleges study. Gina Martin, who is finishing her primary care residency and plans to practice in rural Delta, Colo., says she faces $250,000 in medical school debt, which made her choice more difficult.

• More lucrative specialty care. Payment rates for Medicare and Medicaid — the largest payers for primary care by far — tend to reward specialty, interventionist care over prevention, primary care and diagnosis, says health care consultant Kip Piper. Family physicians made an average of $175,000 in 2012, the third lowest of any doctor, according to the MedScape annual physician compensation report.

• Scope of practice laws. States regulate and license doctors and have been slow to embrace the idea that non-physicians could take over some of the functions. Nurse practitioners and physician assistants should be performing vaccinations and strep tests, Bharucha says.

Despite the challenges, Martin says her intention to pursue the field has never wavered. "I grew up in a system and I'm now training in a system that works toward keeping people as healthy as possible," she says.