Editorial

Primary Care Physician Shortage, Healthcare Reform, and Convenient Care: Challenge Meets Opportunity?

Authors: Amer Kaissi, PhD

Abstract

Primary care in the United States is in a deepening crisis as physician shortages and reduced patient access loom. The healthcare reform law enacted by the US Congress in 2010 will improve the coverage for uninsured and underinsured people and will indirectly address some of the cost problems of the healthcare system, but it does not solve the primary care access conundrum, especially with 32 million people expected to be added to the ranks of the insured by 2019. Consequently, experts warn that “if the primary care foundation of the healthcare system is not strengthened, true access and cost containment may be impossible.”1 Solutions may reside in recent disruptive innovations, striving to make health care more accessible and convenient by relying on nonphysician providers. This article reviews the evidence on primary care physicians shortages and reduced access, discusses the implications of healthcare reform on primary care, and explores several advances in convenient care that may play a role in larger institutional settings such as patient-centered medical homes.

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References

1. Bodenheimer T, Pham HH. Primary care: current problems and proposed solutions. Health Aff (Millwood) 2010; 29: 799–805.
 
2. Cooper RA. Weighing the evidence for expanding physician supply. Ann Intern Med 2004; 141: 705–714.
 
3. Cooper RA. Health care workforce for the twenty-first century: the impact of nonphysician clinicians. Ann Rev Med 2001; 52: 51–61.
 
4. US Department of Health and Human Services Council on Graduate Medical Education.Physician Workforce Policy Guidelines for 2000–2020. Rockville, MD, Council on Graduate Medical Education, 2005.
 
5. Association of American Medical Colleges. The Physician Workforce: Position Statement, June 2002. Washington, DC, Association of American Medical Colleges, 2002.
 
6. Association of American Medical Colleges Center for Workforce Studies. The Complexities of Physician Supply and Demand: Projections Through 2025. Washington, DC, Association of American Medical Colleges, 2008.
 
7. Association of American Medical Colleges Center for Workforce Studies. Help Wanted: More US Doctors. Washington, DC, Association of American Medical Colleges, 2010.
 
8. Centers for Disease Control and Prevention. Overweight and obesity. http://www.cdc.gov/obesity/index.html. Accessed April 27, 2012.
 
9. National Residency Matching Program. Results and data: 2008 main residency match.http://www.nrmp.org/data/resultsanddata2008.pdf. Accessed April 27, 2012.
 
10. Hauer KE, Durning SJ, Keman WN, et al. Factors associated with medical students’ career choices regarding internal medicine. JAMA 2008; 300: 1154–1164.
 
11. Vaughn BT, DeVrieze SR, Reed SD, et al. Can we close the income gap between specialists and primary care physicians? Health Aff (Millwood) 2010; 29: 933–940.
 
12. Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff (Millwood) 2010; 29: 766–772.
 
13. Schoen C, Osborn R, Doty M, et al. Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Aff (Millwood) 2007; 26: w717–w734.
 
14. Bindman AB, Grumbach K, Osmond D, et al. Preventable hospitalizations and access to health care. JAMA 1995; 274: 305–311.
 
15. Hochheiser LI, Woodward K, Charney E. Effect of the neighborhood health center on the use of pediatric emergency departments in Rochester, New York. N Engl J Med 1971; 285: 148–152.
 
16. Hurley RE, Freund DA, Taylor DE. Emergency room use and primary care case management: evidence from four Medicaid demonstration programs. Am J Public Health 1988; 79: 843–846.
 
17. Parchman ML, Culler S. Primary care physicians and avoidable hospitalization. J Fam Pract1994; 39: 123–128.
 
18. Wasson JH, Sauvigne AE, Mogielnicki RP, et al. Continuity of outpatient medical care in elderly men: a randomized trial. JAMA 1984; 252: 2413–2417.
 
19. Fiscella K, Meldrum S, Franks P, et al. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care 2004; 42: 1049–1055.
 
20. Ferrer RL, Hambidge SJ, Maly RC. The essential role of generalists in health care systems. Ann Intern Med 2005; 142: 691–699.
 
21. Goldberg GA, Newhouse JP. Effects of cost sharing on physiological health, health practices, and worry. Health Serv Res 1987; 22: 279–306.
 
22. Lohr KN, Brook R, Damberg C, et al. Use of medical care in the RAND Health Insurance Experiment: diagnosis- and service-specific analyses in a randomized controlled trial. Med Care1986; 24: S1–S87.
 
23. Deleted in proof
 
24. Cherkin DC, Rosenblatt RA, Hart LG, et al. The use of medical resources by residency- trained family physicians and general internists. Is there a difference? Med Care 1987; 25: 455–469.
 
25. Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA 1992; 267: 1624–1630.
 
26. The Patient Protection and Affordable Care Act. http://www.healthcare.gov/law/full/index.html. Accessed April 27, 2012.
 
27. The Uninsured: A Primer. Key Facts About Americans Without Health Insurance. Menlo Park, CA, The Henry J. Kaiser Family Foundation, 2011.
 
28. Shipman S. Physician supply and demand: Trends and implications. Paper presented at ConvUrgentCare Symposium; January 23–25, 2012; Orlando, FL.
 
29. Kaiser Family Foundation. Focus on health reform. Summary of new health reform law. http://www.kff.org/healthreform/upload/8061.pdf. Accessed April 23, 2012.
 
30. Iglehart J. Health reform, primary care, and graduate medical education. N Engl J Med 2010; 363: 584–590.
 
31. Porter S. Provision in health care reform law gives primary care financial boost. AAFP new now. http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20100903primcarebonus.html. Accessed April 27, 2012.
 
32. Perman C. Health-care reform’s major hurdle: doctor shortages.http://www.cnbc.com/id/36036747/Health_Care_Reform_s_Major_Hurdle_Doctor_Shortages. Accessed April 27, 2012.
 
33. Massachusetts Medical Society. 2008 Physician workforce study.http://www.massmed.org/AM/Template.cfm?Section=Research_Reports_and_Studies2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=36166. Accessed August 11, 2012.
 
34. Hooker RS, McCaig LF. Use of physician assistants and nurse practitioners in primary care, 1995-1999. Health Aff (Millwood) 2001; 20: 231–238.
 
35. Jacobsen PD, Jazowksi SA. Physicians, the affordable care act and primary care: disruptive change or business as usual? J Gen Intern Med 2011; 26: 934–937.
 
36. Lin SX, Hooker RS, Lenz ER, et al. Nurse practitioners and physician assistants in hospital outpatient departments, 1997–1999. Nurs Econ 2002; 20: 174–179.
 
37. Estes EH. Training doctors for the future: lessons from 25 years of physician assistant education, in Clawson DK, Osterweis M, (eds): The Roles of Physician Assistants and Nurse Practitioners in Primary Care. Washington, DC, Association of Academic Health Centers, 1993, pp. 109–128.
 
38. Pearson LJ. 1992–1993 update: how each states stands on legislative issues affecting advanced nursing practice. Nurse Pract 1993; 18: 23–28.
 
39. Ryan S. Nurse practitioners: educational issues, practice styles, and service barriers, in Clawson DK, Osterweis M, (eds): The Roles of Physician Assistants and Nurse Practitioners in Primary Care. Washington, DC, Association of Academic Health Centers, 1993, pp. 41–49.
 
40. Safriet BJ. Health care dollars and regulatory sense: the role of advanced practice nursing. Yale J Regulation 1992; 9: 417–488.
 
41. Mundinger MO, Kane RL, Lenz AM, et al. Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA 2000; 283: 59–68.
 
42. Naylor MD, Kutrzman ET. The role of nurse practitioners in reinventing primary care. Health Aff (Millwood) 2010; 29: 893–899.
 
43. Mehrotra A, Wang MC, Lave JR, et al. Retail clinics, primary care physicians, and emergency departments: a comparison of patients’ visits. Health Aff (Millwood) 2008; 5: 1271–1282.
 
44. Lin DQ. Convenient care clinics: opposition, opportunity, and the path to system integration. Front Health Serv Manage 2008; 24: 3–11.
 
45. Merchant Medicine home page. http://www.merchantmedicine.com. Accessed April 27, 2012.
 
46. American Academy of Urgent Care Medicine. Future of urgent care. http://aaucm.org/About/Future/default.aspx. Accessed April 25, 2012.
 
47. Virtuwell home page. https://www.virtuwell.com. Accessed May 12, 2012 .
 
48. White Glove Health home page. http://www.whiteglove.com.Accessed May 12, 2012.
 
49. Christensen C, Bohmer R, Kenagy J. Will disruptive innovations cure health care? Harv Bus Rev 2000; 78: 102–112.
 
50. Deloitte Center for Health Solutions. 2011 survey of health care consumers in the United States. Key findings, strategic implications. http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/US_CHS_2011ConsumerSurveyinUS_062111.pdf. Accessed August 11, 2012.
 
51. National Conference of State Legislatures. More patients under federal law health reform with fewer primary care doctors spell trouble. http://www.ncsl.org/issues-research/health/a-primary-problem.aspx. Accessed May 2, 2012.
 
52. American College of Physicians. Nurse Practitioners in Primary Care. Philadelphia, American College of Physicians, 2009.
 
53. Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff (Millwood) 2009; 28: 64–74.
 
54. Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an increasing and aging population? Health Aff (Millwood) 2008: 27: w232–w241.
 
55. American College of Physicians. Patient-centered medical home. http://www.acponline.org/advocacy/where_we_stand/medical_home. Accessed May 2, 2012.
 
56. Pollack CE, Gindengil C, Mehrotra A. The growth of retail clinics and the medical home: two trends in concert or in conflict? Health Aff (Millwood) 2010; 29: 998–1003.
 
57. American College of Physicians. The impending collapse of primary care medicine and its implications for the state of the nation’s healthcare: a report from the American College of Physicians, January 30, 2006. http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf. Accessed May 2, 2012.