Primary care workforce shortage: Some more solutions

In Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage the National Institute for Health Care Reform observes that the primary care workforce expansion components of the Affordable Care Act will not be sufficient to meet demand. The funding and other incentives to encourage the training of new primary care physicians will take a long time to impact the system. The Institute makes two additional proposals:

  • Allow advanced practice nurses to work independently (without physician supervision) as some states have done
  • Adopt payment policies that increase primary care practitioner productivity by encouraging teamwork

Both of these proposals are ok as far as they go. In many cases nurse practitioners are doing a fine job providing primary care; in other cases patients would benefit from the added training and experience of physicians. A medical home or team based model is also a good idea, although it may not automatically lead to an expansion of primary care capacity. As the analysis indicates, some medical homes begin by reducing panel size.

There’s no single solution that will be adequate. Therefore let me propose a couple more ideas:

  • Encourage increased immigration of primary care physicians. Foreign-born doctors are already a major component of the primary care workforce, but in recent years the US has become less welcoming of immigrants and foreign doctors have enjoyed better opportunities in their home countries. We might as well take advantage of a willing, well-trained labor pool –and the expansion can happen quickly
  • The analysis is silent on the fact that female primary care physicians tend to work fewer hours than their male counterparts and retire earlier –often when they take time off to have children. There should be a greater focus on retaining female physicians in the workforce and encouraging them to work more hours. One area to address: re-entry into clinical practice after time away



January 4, 2012

5 thoughts on “Primary care workforce shortage: Some more solutions”

  1. In my view, the real “doc fix” is the Direct Primary Care model. It’s one of the least reported on elements of PPACA and has bipartisan support (new bill HR 3315 to expand to Medicare). With customer satisfaction rates higher than Google and Apple, much better compensation/lifestyle for the MDs and it reducing expensive downstream costs 40-80%, it’s a virtual no-brainer.

    Click on this link to coverage/commentary in Forbes, Reuters, Huff Post, TechCrunch, KevinMD, etc.

  2. Our Direct Primary Care practice, MedLion, has been doing extremely well. We are the only such practice in California, the state with the highest number of uninsured. Just today, we launched our Fresno location. We aim to be in 50 locations by year end.

  3. David – The “real world” question is a good one. Dr. Qamar’s MedLion is a great example (disclosure: they are a customer) of the meeting the pent up frustration that both individuals and physicians have with the hamster-wheel model of primary care that has worsened things. I have yet to hear of a primary care doc who is operating in the legacy, fee-for-service reimbursement environment who thinks it’s working.

    The striking thing to me is a dramatic uptick of interest in Direct Primary Care in the last 8 weeks. Because I’ve written and studied the DPC models so much (see for examples), I’m given a heads-up on many of them. Not only are there a ton of individual MDs making moves in this direction, but there are some very serious, experienced teams that have formed, are getting funded, etc. to pursue this sea change. They are coming at it from several angles. It’s also noteworthy that carriers are increasingly recognizing the opportunity with DPC models in the insurance exchanges. They recognize that they’ll be at a competitive disadvantage if they don’t add DPC into their offering.

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