Will primary care fail us?

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The Affordable Care Act’s Medicaid expansion is set to take place in just over half of the states. Additional private insurance expansions using health insurance exchanges are set to take place in the next 100 days. However, providing health insurance to a cohort of previously uninsured Americans will strain .

A recent study estimated the magnitude of the insurance expansions and compared it across primary care service areas to determine the balance between supply and demand for primary care services. Data were gathered from sources such as the Census Bureau’s Current Population Survey, the Dartmouth Atlas of Health Care, the MEPS and NAMCS surveys, the AMA Masterfile, and the Robert Graham Center’s National Plan and Provider Enumeration System.

Utilizing all these varied data sources, the authors sought to determine primary care service areas where demand for health care would exceed supply assuming that 29 million Americans will gain coverage through the Affordable Care Act.

For a population of 309 million Americans, there were 290,000 primary care providers (205,000 are physicians) supplying 542 million visits. The Affordable Care Act’s coverage expansions will result in an estimated 25.7 million more primary care visits which would require an additional 7,200 primary care providers. Examining the impact on smaller regions revealed that some areas – especially those with smaller populations, fewer per capita providers, lower incomes, and higher minority (Black and Hispanic) populations – will demonstrate the greatest need for additional providers.

Forty-four million Americans live in a primary care service area requiring a greater than 5% increase in provider supply. Seven million Americans live in areas that will experience a need to increase primary care supply by 10% or more.  The states with the greatest need include Texas, Mississippi, Louisiana, New Mexico, Nevada, Florida, Arizona, Georgia, Arkansas, and Oklahoma.

Commentary

A new batch of medical school graduates start their residencies today. But anywhere from 7 to 44 million Americans currently live in areas that desperately need more primary care providers as early as the next 6 months. As has been discussed in other research, there is much concern that .

This study provides a tangible number on the extent of this problem. Yet, the solutions cannot rest solely on the training of new physicians, a group of clinicians where fewer than 25% of new entrants go into primary care jobs.

, including physician assistants and nurse practitioners, are an important component to solving the primary care problem in the United States.

As we discussed last week, if state legislatures liberalize their scope of practice statutes. However, two other important issues must also be considered. First, reimbursement for primary care services must become more competitive to incentivize physicians to enter those fields. Secondly, of physicians.

Huang, ES and Finegold, K. Health Affairs. 2013; 32 (3): 614-621.

by

Cedric Dark, MD, MPH

One Reply to “Will primary care fail us?”

  1. Another huge point that must be addressed, and something that has personally swayed me away from primary care, is the issue of the increased documentation and paperwork I hear many in that field complaining about. I didnt go into medicine to be a paper pusher/ social worker, and many will run away and fast from the field if that’s the perception that gets filtered down to students.

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