Will we have enough primary care physicians in upcoming years?

Robin Wulffson MD's picture
physician shortage, primary care, Affordable Care Act, baby boomers
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Implementation of the Affordable Care Act plus an increase in US population in general and among seniors will necessitate a significant increase in the number of primary care physicians. The obvious question is: Will we have enough of these physicians to meet our needs? Many healthcare experts feel that the answer is “no.” Stephen M. Petterson, PhD, who is affiliated with the Robert Graham Center, Policy Studies in Family Medicine and Primary Care in Washington DC, and colleagues published their findings in the November/December issue of Annals of Internal Medicine.

Before Congress enacted the Affordable Care Act in 2010, the Association of American Medical Colleges had forecast a shortfall of 46,000 primary care physicians by 2025. However, its passage will increase the need of these doctors. In view of this situation, the researchers attempted to project the number of primary care physicians required to meet US healthcare utilization needs through 2025 after passage of the Affordable Care Act.

To develop their projection of workforce needs, the authors accessed the Medical Expenditure Panel Survey to calculate the use of office-based primary care in 2008. They used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfile to calculate the number of primary care physicians and determine the number of visits per physician. The main outcomes were the projected number of primary care visits through 2025 and the number of primary care physicians needed to conduct those visits.

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The authors projected that, driven by population growth and aging, the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. After incorporating insurance expansion, the US will require almost 52,000 additional primary care physicians by 2025. They noted that population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, marking a 3% increase in the current workforce.

The authors concluded that population growth will be the greatest driver of expected increases in primary care utilization. Aging and insurance expansion will also contribute to utilization, but to a smaller extent.

Take home message:
I agree with the majority of healthcare analysts that the shortage of primary care physicians will increase in the near future. This study estimated the additional number of primary care physicians needed to accommodate the increased demands by population growth, an increase in the senior population, and the Affordable Care Act. However, another factor is likely to add to the shortage. Many physicians have threatened to cease practicing when the Affordable Care Act is implemented. Some of these doctors will continue to soldier on; however, a significant number will quit. Many physicians are already struggling with the double whammy of decreased reimbursement and rising costs for the running of a medical practice. I am personally aware of a number of fine physicians who are currently enduring stress and financial difficulties. Sadly, many of the struggling physicians are the ones most valued by patients. They are the ones that take extra time with each patient to fully address his or her needs. Physicians who see a high patient volume with a rapid turnover are faring better.

Reference: Annals of Family Medicine

See also: Pre-existing conditions and the Affordable Care Act: what you need to know

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Comments

A number of years ago, when doctors in an Israel hospital went on strike, the death rate dropped significantly. Which gives credence to the Latin proverb; "The doctor is to be feared more than the disease."---- Modern medicine is the leading cause of death, 783,936 1 every year in the USA alone. That is over 2 million Iatrogenic deaths worldwide every year. Then add on the 5-10 million who die every year due to suppressed medicine such as Vitamin C. Modern medicine, with its emphasis on suppressing symptoms under a blanket of drugs is not scientific! It isn't even pseudo science. Do we need more of this? Or do we need more health education? What we have at present is more hospitals, more doctors, with more patients, more accidental deaths, and no health education! We need to exercise more control over what we eat. After all we are what we eat. We need to take the resposibility for our health into our own hands, rather than do all the wrong things and expect 'a pill for every ill' to do the miracle healing. There is no miracle healing! We ourselves are the healers.
US physicians range from mediocre to poor. Unfortunately, some of the excellent ones who spend time with their patients are struggling financially. Although, physicians have harmed patients, a large portion of illnesses are self-inflicted via poor life style choices such as substance abuse and lack of exercise. Although the health hazards of smoking and obesity are well publicized, many turn a deaf ear to them. If the majority of Americans practiced a healthy life style, we would need far fewer doctors and hospital beds. For example, pulmonary specialists see many patients with COPD and other respiratory problems due to smoking.
In Australia the fee for a consultation is $50, (more in some areas) for a 10 minute assessment. That is $300 plus an hour! And they are busy! I find it difficult to imagine a doctor struggling financially!
Sadly, many US physicians are struggling. The fees are offset by the high cost of doing business: rent, employees, equipment, and malpractice insurance. When I ceased practicing in 1996, my malpractice insurance was $40,000 per year. Also, many physicians belong to health networks that restrict their fees. In a number of cases, the reimbursement does not cover costs,excluding any fee for the physician. For example, a radiologist friend of mine receive $30 for an IVP (kidney X-ray). That did not cover the cost of the film and X-ray tech. Besides, X-ray equipment is expensive.
The malpractice fee is so high because of the amount of malpractice. Iatrogenic injury is costly; at least 10% of admissions to acute-care hospitals in Australia are associated with a potentially preventable adverse event. It has been estimated that the direct medical costs of these events exceeds $2 billion per year and that the total life-time cost of such preventable injury may be twice that amount; there is also a heavy toll in human costs on both those who are harmed and those who care for them. Furthermore, medical misadventure consumes over half the amount spent on compensation and insurance by State Treasury Departments. By analysing information obtained using these methods it was determined that at least 10% of admissions are associated with a potentially preventable adverse event, and that such adverse events are associated with as many as 50,000 permanent disabilities and 16,000 deaths each year in Australia. These figures are thought to be the tip of the iceberg! (IATROGENIC INJURY IN AUSTRALIA)
Health Minister Lawrence Springborg says the Queensland Government will leave "no stone uncovered" when investigating widespread fraud accusations against doctors in the public health sector. The Crime and Misconduct Commission (CMC) and auditor-general have begun looking into allegations some specialists used public facilities to treat private patients, without refunding the Government. Mr Springborg says both agencies could provide evidence to the Director of Public Prosecutions if they uncover any wrongdoing. The World Today By Stephanie Smail Updated Mon Nov 12, 2012 4:18pm AEDT Mr Springborg says a preliminary investigation indicates fraud is widespread within Queensland Health. (ABC TV News) Investigations are underway into claims that a medical specialist working full-time for Queensland Health has made an extra $2 million treating private patients in public facilities. Specialists are allowed to treat private patients in public facilities, but they have to inform Queensland Health and share their fees. The State Government says it is proof the health system is vulnerable to fraud and has vowed to stamp out the problem. Health Minister Lawrence Springborg says preliminary investigations into the claims have revealed worrying trends. Do we need more of this?