While there’s little debate about a growing primary care workforce shortage in the United States, it’s less clear whether existing workforce policies—such as educational loan forgiveness or scholarships and higher payment rates—can boost the supply of practitioners quickly enough, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).
Written by researchers at the Center for Studying Health System Change (HSC), the policy analysis examines whether “policy makers may want to consider ways to increase the productivity of primary care providers and accelerate primary care workforce expansion by, for example, examining how changes in state scope-of-practice policies might increase the supply of non-physician practitioners.”
According to the policy analysis, “Most efforts to improve access to primary care services center on increasing the supply of practitioners through training, educational loan forgiveness or scholarships, credentialing, and higher payment rates. The 2010 Patient Protection and Affordable Care Act includes many provisions promoting these strategies. While existing, longer-term efforts to boost the primary care workforce are necessary, they may be insufficient for some time because a meaningful increase in practitioners will take decades.”
Collectively, an estimated 400,000 practitioners, including physicians, advanced practice nurses (APNs) and physician assistants, provide primary care in the United States. Primary care physicians are typically categorized as those specializing in family medicine, pediatrics or internal medicine.
Most national studies indicate that the supply of primary care practitioners is growing but not fast enough to keep pace with demand. For example, the Health Resources and Services Administration (HRSA) estimates an additional 17,722 primary care practitioners are already needed in shortage areas across the country to meet a target of one provider for every 2,000 patients. Likewise, other research indicates that another 35,000 to 44,000 adult primary care providers may be needed by 2025 to care for the nation’s aging population.
The policy analysis examines two other possible approaches to increase primary care capacity—expanding state scope-of-practice policies and adopting payment policies that foster increased productivity of primary care practitioners through team-based care.
- Expanding Scope of Practice. Given the supply of advanced practice nurses currently delivering primary care and the shorter time frame required for training new entrants, broadening scope-of-practice laws for APNs is a possible avenue to expand primary care capacity more rapidly. State scope-of-practice laws, which determine the tasks non-physician health professionals can perform and the extent to which they may work independently, vary widely. Changing these laws is a highly politicized process and has generated considerable controversy among APNs and physicians.
- Payment Policies for Team-Based Care. Changing the way practitioners are paid can have an immediate effect on the amount and type of care they deliver. A variety of payment methods beyond those enacted by health reform law can potentially augment primary care capacity. These methods, such as capitated payments that put providers at risk for the cost of care or case management models that provide additional payments for care management, may incentivize and encourage the development of teams that share care responsibilities. These teams potentially can deliver more primary care to a greater number of patients than a physician working alone could provide, though there are concerns about physician satisfaction and whether team-based care truly increases efficiency.
The Policy Analysis—Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage— is available here and was written by Emily R. Carrier, M.D., M.S.C.I., an HSC senior researcher; Tracy Yee, Ph.D., an HSC researcher; and Lucy Stark, an HSC health research assistant.