The ongoing debate on healthcare reform is difficult to avoid, as healthcare is a need that affects every single person in the nation. In a country with a wide chasm between the rich and the not rich, it is unsurprising that much of the focus when discussing the Affordable Healthcare Act or ACA (or Obamacare) is about money. How the approximate 11 million Americans who have gained insurance post-Act, and rightfully so, would affect our already palpable doctor shortage was covered to a lesser degree. In March, the Association of American Medical Colleges (AAMC) reported that the U.S. physician deficit is projected to reach an estimate of between 46,100 and 90,400 doctors by 2025. A third of which will likely be primary care physicians.
To be fair, only about 2% of this projected demand is due to the ACA’s implementation while the bulk of the shortfall originates from a population increase, an improving economy, and the retirement of the baby boomers who began turning 65 in 2011. Even though the need for more primary care physicians only makes up about a third of the projected demand, most Americans under the age of 65 typically seek a primary care physician as opposed to a specialty one, such as an orthopedic surgeon or an oncologist, so the shortage still hurts.
For women ages 25-55 with normal, non-urgent primary care needs, the good news (or the bad news depending on your patience levels) is the most you’ll be “hurt” directly by the shortage is by experiencing longer wait times or further trips to see a doctor. If your primary care needs are a bit more urgent, the shortage will affect you more adversely and some patients have resorted to visiting community health care centers, retail clinics, and hospital emergency rooms, which may lead to paying more money out of pocket.
Medicaid, Medicare, and Health Professional Shortage Areas
Women ages 25-55 who will be most affected by this primary care shortfall are those who use Medicaid or Medicare and those who live in one of the 5,800 areas in the U.S. known as Health Professional Shortage Areas or HPSAs. Primary care physicians are able to choose whether or not they want to accept Medicaid and Medicare and many decline to do so because the compensation with the programs is much less than with privately-owned insurance companies. If you have Medicaid and the nearest primary care physician chooses not to accept it, you are essentially out of luck and must continue your quest to find a doctor who does. If you come across a doctor that doesn’t accept Medicare, this will only affect you if you are the caretaker of someone who is 65 or older or you yourself have a severe disability. And if you have a severe disability, chances are you are seeking specialty care and not primary care.
The other group disproportionately affected by the shortage is the estimated 58 million Americans, roughly 18% of the population, who live in HPSAs where access to primary care falls below a federal standard. Often these areas are in inner-city communities or sparsely populated rural towns where physicians, even with various incentives such as student loan reductions, simply don’t want to locate their practice. You can find out if you live in an HPSA by visiting the US Department of Health Website. With both HPSAs and the Medi-issue, again longer wait times and longer drives will be your main obstacle. How adversely this affects you depends on the severity level of your primary care needs.
Alternatives to Combat the Primary Care Shortage
As is often the case with the news, some are saying that the primary care shortage, though accurate, will not be as ruinous as it is made out to be and plainly fails to acknowledge the growing number of alternative options to our traditional healthcare delivery system. In addition to new technologies, such as tele-health and medical apps, there are three types of “physician extenders” that can be more heavily utilized to alleviate the primary care shortage. They are Nurse Practitioners (NPs), Physician Assistants (PAs), and Foreign Medical Graduates (FMGs), who are actually physicians but didn’t attend medical school in the US. They are typically at the top of their classes in their respective countries.
Many medical insiders believe that primary care needs to evolve into a more team-centric approach so that NPs and PAs can have a more authoritative role in our primary care system. Roughly 90% of NPs are actually already trained in primary care so expanded roles are feasible. The NP and PA workforce is projected to increase more rapidly than the physician supply, from 55,400 in 2010 to 72,100 in 2020 for primary care NPs and from 27,700 to 43,900 for primary care PAs. Respectfully, that’s a 30% and 58% increase. If a system is developed where NPs and PAs are able to deliver primary care with more authority, some project that the primary care physician deficit could fall to under 7,000.
FMGs are another option to combat the primary care shortage and many health care systems are already relying on them to meet demands. The top areas of practice for FMGs conveniently are all in primary care: internal medicine, family medicine, and pediatrics. Currently, there are roughly 800,000 physicians in the U.S. and about 30% of those are FMGs. This is not a matter of taking medical space from graduates of American institutions. This is a matter of there simply not being enough physicians coming out of our medical schools and residency programs. FMGs come with their own sort of issues (e.g., critics of international “brain drain” or the opposite, FMGs returning to their respective countries). In the end, FMGs still have to go through intensive training to ensure they meet American medical standards. Additionally, their work visas and immigration statuses often come with the stipulation that they work in an HPSA for a certain number of years.
Patience and Acceptance During The Primary Care Shortage
There is no doubting that there is a shortage of physicians for our ever-growing, ever-aging nation. However, freaking out about the non-urgent primary care aspect of it seems to be the equivalent of freaking out over a shortage of white flour for your chocolate chip cookies when you have a bag of wheat flour in the pantry or you can just go to a grocery store to buy another bag. Primary care has the luxury of being a less specialized field where patient needs are typically not as urgent. As a primary care patient, you will be affected by the shortage but you also have the options to book an appointment well in advance with the doctor nearest you who accepts your insurance and prepare a plan to get to your appointment if travel is an issue. For both urgent and non-urgent primary care needs, being more accepting of being treated by an NP or a PA as opposed to just a physician, including the large number of FMGs already in our system, will increase the chances of these well-trained workers attaining more primary care responsibility and you being able to get the care you need in a timely manner.
