We frequently hear about the national shortage of primary care physicians, with the potential shortfall amounting to 40,000. Moreover, many take it as a given that the newly covered—through Medicaid or state exchanges—will not be able to find a personal physician. Through a variety of experiences and conversations with physicians, I have concluded that the problem may not be as severe as anticipated. Here’s why.
A physician leader at Partners HealthCare in Boston was one of the first who led me to question the conventional wisdom on this concern. “People underestimate the ability of physicians to make adjustments to meet demand. I am confident we can meet this challenge.” This young physician and the depth of his experience in the Massachusetts market made a strong impression on me and gave me pause.
Being on the board of directors of Doctors Care, which provides medical services to the uninsured and those on Medicaid in the south Denver area, also influenced my thinking. Doctors Care has acquired new clinical space and will be able to expand to meet increased demand. This not-for-profit uses mainly physician assistants (PAs) and nurse practitioners for primary care, and it relies on a network of 1,000 physicians plus five hospitals for more serious cases.
My early experience in rural parts of Kansas, Montana, South Dakota, and Colorado has convinced me that physician extenders can handle 90 to 95 percent of the patients who present themselves. People in rural areas think this approach to care is just fine. They often refer to these providers as “doc.”
Having just read a summary of the rapid growth of medical offices in big box retailers or pharmacies (staffed by PAs and nurse practitioners) is encouraging. These outlets can carry some of the new load from patients with a payment source. It is obvious that many patients like this approach to care.
Under the Affordable Care Act, there is significant additional funding for the more than 1,000 federally qualified health centers. This funding should help increase the capacity of these centers to handle new patients.
Finally, there is the use of IT as a way of expanding the scope of primary care. I personally communicate with my physician via email, and I am certain that being able to do so has eliminated half of my need for office visits. This way of communicating with physicians, especially those in larger systems where they are paid on a capitated basis, offers some encouragement. Are there other technological fixes out there?
Although this assessment of the potential primary care physician shortage problem is based primarily on anecdotal evidence, that evidence encourages me to think we may be in better shape than the conventional wisdom would expect.
Dean C. Coddington is a senior consultant, McManis Consulting, Denver, and a member of HFMA’s Colorado Chapter.
Publication Date: Wednesday, April 24, 2013