By Debra Wood, RN, contributor Dec 12, 2017
A looming shortage of primary care physicians threatens access to care and improved health for American citizens at a time when the population is growing and aging.
“I have no doubt there will be an increasing shortage of primary care and subspecialty physicians, getting worse as we head to 2030,” said Steven Lee Berk, MD, dean of the School of Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas.
“The greatest concern is primary care physicians,” he emphasized.
Berk explained that primary care physicians have a far-reaching impact on individuals and the overall public health, as they help decrease the likelihood of coronary heart disease and heart failure, find cancers early on, give vaccines to prevent infections and increase lifespans.
Clese Erikson, MPAff, deputy director of the Health Workforce Research Center at The George Washington University in Washington, DC, agreed that a shortage of primary care physicians exists, but said nurse practitioners (NPs) and physician assistants (PAs) are helping fill the role, particularly in certain rural and underserved areas.
Both Berk and Erickson described primary care shortages in some areas of the country, but not others.
Physician shortage stats
Staff Care’s 2017 white paper, Locum Tenens and the Emerging Shortage of Medical Specialists, points out that primary care physicians—generally defined as family practice physicians, internists and pediatricians—will account for approximately 4 out of every 10 physician vacancies over the next several years.
The Association of American Medical Colleges (AAMC) in 2017 projected a deficit of up to 104,900 physicians in the U.S. by 2030. This includes a shortage of up to 43,100 primary care physicians, and a shortage of up to 61,800 specialist physicians.
And some of these vacancies will be filled with locum tenens.
The 2017 Survey of Temporary Physician Staffing Trends, conducted by Staff Care, found that primary care represented 43.5 percent of the locum tenens providers used in 2016.
It also reported that between 38-40 percent of primary care physicians are 55 years or older, nearing retirement age.
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What’s causing the shortage of primary care physicians?
Numerous factors are expected to contribute to the growing primary care physician shortage, including the upcoming wave of older physicians retiring; more medical residents choosing to specialize; the increasing number of older Americans, who use more health care services; and a growing population.
The 2017 AAMC report projects the U.S. population will grow by about 12 percent to 359 million in 2030. And the number of people age 65 and older will grow by 55 percent.
Additionally, Berk said that the newer generations of physicians do not plan to work as many hours as physicians did years ago.
Erickson echoed that, saying newer physicians value work–life balance.
Solutions to the primary care physician shortage
The AAMC suggested a multipronged solution to the physician shortage in primary care.
Medical students frequently gravitate to specialties, because the pay is better. The Medscape Physician Compensation Report 2017 said primary care physicians earn about $217,000 annually, while specialists earn an average of $316,000. That extra income goes a long way in paying off medical school loans.
Berk explains many medical students are worried about the finances. He called tuition reimbursement or the ability to pay back loans an important issue. However, if primary care is attractive enough and prestigious enough, he thinks students will select that path.
“It’s important to have medical school see primary care providers who enjoy what they do and have strong patient relationships,” Erikson said.
Berk at Texas Tech created a three-year family medicine accelerated program. Texas Tech gives students in the program a scholarship for the first year’s tuition. By the second year, the medical students do a clerkship and are seeing patients and working side by side with licensed family medicine physicians and experiencing the joys of the profession. They also go to family medicine conferences, where they can network.
“We developed a program that makes family medicine attractive and gives it some prestige,” Berk said. “And they have role models.”
Students in Texas Tech’s regular medical program also often select family medicine. Berk attributes that to the students in the accelerated program talking up primary care. Texas Tech is 12th in the nation in the percent of graduates selecting family medicine.
The AAMC suggests that expanding federally funded graduate medical education is a prime solution to the primary care shortage. The organization suggests additional federal support to train at least 3,000 more doctors annually is needed.
Berk explained that caps on graduate medical education funding contributes to the shortage, because even though medical schools have increased enrollments, newly minted physicians must complete a residency before they can practice medicine. Therefore, more residency slots are needed.
Physicians and advanced practitioners in primary care
In a report to Congress, the University of Pennsylvania School of Nursing reported that the $200 million Medicare Graduate Nurse Education Demonstration project has increased the primary care workforce. Advanced practice registered nurse (APRN) enrollment and graduation growth in demonstration schools were higher than other educational programs.
Advanced practice nurses trained through the demonstration project are practicing in a variety of settings, including federally qualified health centers.
Berk agreed that NPs play an important role, particularly in a team environment.
The 2017 AAMC report indicates that the supply of nurse practitioners and physician assistants has increased, and the ratio of physicians to mid-level providers will decrease to 3.5 to 1 in 2030. Erikson pointed out that many NPs and PAs enter specialty care.
Erikson added that care coordination in team and value-based care environments complement but do not necessarily decrease the need for physicians, but they can be rewarding for care providers. She also said telehealth has the potential to increase access for patients.
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