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Senate reports on shortage of primary care providers

Wednesday January 30, 2013
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Statistics from the Health Resources and Services Administration indicate a shortage of 15,928 primary care providers as of the end of 2012.

That number of PCPs would be needed to fill a gap of 5,848 health professional shortage areas with 56.8 million people living in them.

The deficit is expected to increase with full implementation of the Affordable Care Act, which the Congressional Budget Office projects will insure 14 million additional people in 2014 and 29 million to 30 million by 2022. By that year, according to a 2012 study in the Annals of Family Medicine, 52,000 additional PCPs will be needed.

The data were cited in a report issued Jan. 29 by the U.S. Senate Subcommittee on Primary Health and Aging, which stated that "insurance coverage alone does not guarantee access."

"Despite the fact that over half of patient visits are for primary care, only 7% of the nation’s medical school graduates now choose a primary care career," according to the Senate subcommittee report, citing information from a 2011 Commonwealth Fund report.

The Senate subcommittee report noted various implications of the shortage for patient care, including average delays of 45 days for new patients to see a family doctor and lack of access on evenings and weekends.

"Today millions of Americans — one in five sick people — visit the emergency room for care they could have received from their primary care practitioner," according to the Commonwealth Fund information cited in the Senate subcommittee report. "In fact, half of emergency room patients would have gone to a primary care provider if they had been able to get an appointment at the time one was needed. … Our system places a heavy burden on emergency rooms and emergency providers."

Thus, according to the Senate subcommittee report: "It is not only our moral responsibility to ensure primary care access now and in the future, but it is fiscally sensible to act quickly to expand this critical workforce."

Solutions

The Senate subcommittee recommends expanding community health centers to serve more people, using appropriated funding in the Affordable Care Act; and expanding the Teaching Health Center program, created by the ACA "to move training out of academic teaching hospitals and into community-based settings, where most medical care across the country is delivered."

"Studies have shown that residents trained in community health centers or rural communities are more likely than those trained in other settings to make a career practicing in underserved or rural areas," according to the report. Although current funding for the program is expected to produce 600 new primary care residents by 2015, "the scope of the need in this country is so great that this program must be dramatically expanded."

The subcommittee also recommends steps such as providing medical schools with additional funding if they meet a benchmark goal for sending graduates into primary care residencies; increasing reimbursement under Medicare and Medicaid for primary care providers; and placing physicians and nonphysicians together for portions of their training to better prepare students for providing team-based approaches to care.

"Care teams extend the reach of all providers and better meet the needs of patients," according to the report.

Expanding the National Health Service Corps, which provides scholarship and loan repayments to those committed to serving in areas with the greatest need for more providers, would bolster the primary healthcare workforce in areas that need it most, according to the report.

Allied health providers

The report noted that nurse practitioners account for 19% and physicians assistants 10% of the U.S. primary care workforce. "Studies have shown that the NPs and PAs are safe, effective and improve access to care," according to a report, citing a recent study in the journal Health Affairs.

"Some workforce experts believe that the need for additional primary care providers could be met by including shared practice and team approaches to the delivery of care and by permitting allied health professionals to practice at their highest level of training.

"Additionally, the shorter length of training for nonphysician primary care providers means that people can begin to practice more quickly and often graduate with less educational debt. They are also more likely to choose primary care careers and are known to be more nimble in their ability to move between primary care and specialty careers."

A PDF of the Senate subcommittee report is available at www.sanders.senate.gov/imo/media/doc/PrimaryCareAccessReport.pdf.


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