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