America’s Looming Primary Care Doctor Shortage

Tomorrow’s graduates of traditional and online public health degree programs are poised to take advantage of the benefits of the Patient Protection and Affordable Care Act (PPACA), including electronic health records that will offer massive amounts of data to make invaluable public health predictions. Unfortunately, without primary care doctors, the new system will be built on a crumbling foundation. In addition to being a patient’s first line of care for a range of health problems, primary care physicians are the gatekeepers for medical care in the new system structured by the PPACA. As the health care law goes into supercharged effect in 2014, the lack of medical generalists could become a serious conundrum.

Just How Bad Is the Problem?
According to current estimates, the U.S. is short about 16,000 primary care doctors, leaving 55 million Americans either without a doctor or looking for one. Only 32 percent of current pre-med students expect to pursue careers in primary care. The Association of American Medical Colleges predicts that the shortage will grow to 90,000 by 2020. Another alarming fact: Nearly half of the country’s current doctors are over 50 years old, and most doctors see fewer patients than they did in the past. Also, 60 percent say that they wouldn’t recommend medicine as a careerand 84 percent say that the profession is in decline.

As the baby boomers head for retirement, an additional 15 million seniors will pour into the Medicare system in the next few years. Add 30 million newly insured people thanks to the PPACA, and the U.S. health care system is headed for a perfect storm. The major cause of the shortage is the cost of medical school. Many medical students graduate with debt approaching $250,000. To pay their student loans, they opt for higher-paying specialties instead of lower-paying primary care. Both universities and the U.S. government are taking some steps to try to re-tilt the balance back toward generalists.

Making Med School Cheaper: Accelerated Education
To help reduce medical school costs, some universities have created accelerated programs for students who want to become primary care physicians. Three major universities have developed accelerated three-year medical school programs for students willing to pursue primary care.

Critics of shortened programs worry that three years may not provide enough time for students to be steeped in the necessary knowledge and experience required to succeed in residency programs. Universities would have to put strict standards in place to ensure that they weren’t graduating underqualified doctors.

Throwing Money at the Problem: Extra Medicare Payments
The Obama administration started providing primary care physicians with an additional 10 percent Medicare incentive payment in 2011, and many private insurers have followed suit. The government and private insurers may also provide incentive payments to practices to enable them to develop advanced primary care capabilities in exchange for 24-hour patient access. While the incentive payments could produce positive results, partisan bickering has placed these funds in danger of being cut.

The Relief Pitchers: Nurse Practitioners and Team-Based Care
16 states have given nurse practitioners the ability to work at the primary care level. These professionals can see patients for checkups as well as order and interpret diagnostic tests. Another concept includes the idea of team-based care, in which a doctor would lead a team of medical professionals that would coordinate care with the patient and family. Unfortunately, many more states have to get on board with this solution, and funding, once again, is on the chopping block.

Other Options: Telemedicine and Community Health Centers
The PPACA has provisioned funds to promote telemedicine, particularly in rural areas of the U.S. Instead of driving for hours to see a doctor, patients in rural areas could ask basic questions over videoconference. Also, community health centers can be more empowered to provide primary care. PPACA has set aside $42 million over three years to provide 500 community health centers in 44 states with the chance to expand their services and improve their quality of care.

Fortunately, experts are seeing some hope on the horizon. In 2012, 45,000 first-time applicants applied to medical school, which is a record-setting 3.4-percent increase over 2011 levels. Hopefully, universities can tempt these students toward primary care. In the meantime, state and federal lawmakers have to begin examining—and funding—other alternatives.


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