Healthcare Labor Issue: The Short Supply of U.S. Primary Care Providers

...

One of the key elements of the ACA guidelines is the growing number of medical care visits that will occur with physician’s assistants (PAs) or APRNs. As a result, these academic programs are growing at a dramatic rate, providing new opportunities for health care students and professionals. The rigor and sophistication of these programs is also growing, with more implementing a leadership scope that can translate into future leadership positions for PAs and DNPs in primary care settings (Lathrop & Hodnicki, 2014). The expanding scope of these programs is making a health care career more plausible and attractive for more people and serves to further reduce the shortage of primary care providers in the coming years (Mundinger, 2010).

Finally, there are socioeconomic and professional cultural factors that may reduce the primary care provider gap. The increased private insurance coverage mandated by the ACA should generally reduce the average the average age of people seeking primary care, particularly post “aging-out” of the Baby Boom generation (Faulkner et al., 2011). One goal of the ACA is to diversify the patient population age, making it less homogenous, and creating a greater variety of patient types (Carroll et al., 2013). This in turn could make the choice of a primary care provider career more attractive for younger care providers, in part because of the opportunity to exercise long-term preventative care measures that leverage education and lifestyles choices instead of simply prescribing medication or therapy. Primary care providers in the future may be required to have a greater knowledge base and greater access to technology to meet this patient diversification, making this a more challenging, and therefore more attractive, field. The demand for primary care physicians and nurses could lead to more leadership opportunities, a fact that is more apparent in comparison to many specialist and subspecialist environments where there are only a limited number of leadership opportunities that are fulfilled by an aging specialty care workforce.

Recommendations

While these sociocultural changes could help reduce the primary care provider gap, it is likely that financial factors will be far more conclusive in the health care landscape. The ACA makes strides in reducing the shortfall through financial incentives and comprehensive programs. However, it is possible that it would take years or decades for a generation of new students and recently graduated professionals to make decisions that could meet the massively growing demand. Insurance providers continue to play a substantial role in determining the nature and effectiveness of health care. The ACA provides sweeping restrictions in insurance companies (e.g. prohibiting them from denying coverage to customers based on current conditions), but these restrictions may not be enough to meet the future demands. Therefore, one recommendation would be to restrict high-paying reimbursements dedicated exclusively for specialists and to implement cost ceilings on highly specialized equipment. Another potential recommendation would be to restrict cuts to care reimbursements from coverage providers to primary care settings. Together, these steps would make primary care settings more attractive, and highlight the benefits of convenience and relationships with primary care doctors and nurses.

References

Adamapoulos, H. (2014, August). 100 things to know about Medicare reimbursement.

Becker’s Hospital Review. Retrieved from

http://www.beckershospitalreview.com/finance/100-things-to-know-about-

medicare-reimbursement.html

Anderson, A. (2014, March). The impact of the Affordable Care Act on the health care

workforce. Heritage Foundation. Retrieved from

http://www.heritage.org/research/reports/2014/03/the-impact-of-the-affordable-

care-act-on-the-health-care-workforce

Carroll, A. (2013, June). Too few generalist physicians doesn’t necessarily mean too

many specialists. JAMA.com. Retrieved from

http://newsatjama.jama.com/2013/06/26/too-few-generalist-physicians-doesnt-

necessarily-mean-too-many-specialists/

Faulkner, L., Juul., D., Andrade, N., Brooks, B., Colenda, C. et al., (2011, January).

Recent trends in American Board of Psychiatry and Neurology Psychiatric

subspecialties. Academic Psychiatry, 35(1). 35-39.

Health Resources and Services Administration. (2014). Shortage areas. Retrieved from

http://datawarehouse.hrsa.gov/Topics/ShortageAreas.aspx

Lathrop, B. & Hodnicki, D. (2014, March). The Affordable Care Act: Primary care and

the doctor of nursing practice nurse. Online Journal of Issues in Nursing, 19(2).

Retrieved from

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPerio

dicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Articles-Previous-

Topics/Affordable-Care-Act-Doctor-of-Nursing-Practice.html#Leadership

Mundinger, M. et al. (2010, January). Primary care outcomes in patients treated by nurse

practitioners or physicians. Journal of the American Medical Association. 283(1).

Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=192259