Top

Published in:

01-04-2012 | Perspectives

Health Care Reform and the Primary Care Workforce Bottleneck

Author: Mark D. Schwartz, MD

Published in: Journal of General Internal Medicine | Issue 4/2012

Abstract

To establish and sustain the high-performing health care system envisioned in the Affordable Care Act (ACA), current provisions in the law to strengthen the primary care workforce must be funded, implemented, and tested. However, the United States is heading towards a severe primary care workforce bottleneck due to ballooning demand and vanishing supply. Demand will be fueled by the “silver tsunami” of 80 million Americans retiring over the next 20 years and the expanded insurance coverage for 32 million Americans in the ACA. The primary care workforce is declining because of decreased production and accelerated attrition. To mitigate the looming primary care bottleneck, even bolder policies will be needed to attract, train, and sustain a sufficient number of primary care professionals. General internists must continue their vital leadership in this effort.

Patient Protection and Affordable Care Act. Pub L No. 111–148;2010.

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.PubMedCrossRef

Baicker K, Chandra A. Medicare spending - the physician workforce, and beneficiaries’ quality of care. Health Affairs 2004; Web exclusive. Accessed September 27, 2011 at http://content.healthaffairs.org/content/early/2004/04/07/hlthaff.w4.184.full.pdf±html

Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Services. 2007;37:111–128.CrossRef

Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am J Public Health. 1996;86(12):1742–1747.PubMedCrossRef

Kronman AC, Ash AS, Freund KM, Hanchate A, Emanuel EJ. Can primary care visits reduce hospital utilization among Medicare beneficiaries at the end of life? J Gen Intern Med. 2008;23(9):1330–1335.PubMedCrossRef

Colwill JM, Cultice JM, Kruse RL. Will generalist physician supply meet demands of an increasing and aging population? Health Aff (Millwood). 2008;27(3):232–241.CrossRef

Social Security News Release. Nation’s first baby boomer files for Social Security retirement benefits, October 15, 2007. Accessed September 27, 2011 at http://www.ssa.gov/pressoffice/pr/babyboomerfiles-pr.htm.

Chen LW, Zhang W, Adidam PT, Pol L, Mueller K, Shea D. The pent-up demand for health care of the uninsured near elderly when they are approaching age 65. AcademyHealth Meeting 2004; 21: Abstract no. 952.

10.

Hadley J, Holahan J, Coughlin T, Miller D. Covering the uninsured in 2008: current costs, sources of payment, and incremental costs. Health Aff (Millwood). 2008;27:w399–w415.CrossRef

11.

Bindman AB, Schneider AG. Catching a wave - implementing health care reform in California. N Engl J Med. 2011;364:1487–1489.PubMedCrossRef

12.

Council on Graduate Medical Education (COGME) twentieth report to Congress: advancing primary care (2010). Accessed September 27, 2011at: http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentiethreport.pdf.

13.

Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med. 2005;80(5):507–512.PubMedCrossRef

14.

National Residency Matching Program. Accessed September 27, 2011 at: http://www.nrmp.org/data/resultsanddata2011.pdf.

15.

Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK. Who is maintaining certification in internal medicine—and why? A national survey 10 years after initial certification. Ann Intern Med. 2006;144:29–36.PubMed

16.

Sox HC. Leaving (internal) medicine. Ann Intern Med. 2006;144:57–58.PubMed

17.

Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. JAMA. 2010;303(8):747–753.PubMedCrossRef

18.

Salsberg E. Health care reform: implications for the supply, demand and use of physicians. AAMC Center for Workforce Studies; 2010

19.

Howell J, Sum A. Annual physician workforce study: 2010. Waltham: Massachusetts Medical Society; 2011. Accessed September 27, 2011 at: http://www.massmed.org/workforce.

20.

Abrams MK, Nuzum R, Mike S, Lawlor G. Realizing health reform's potential: how the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers the commonwealth fFund issue brief, January 2011. Accessed September 27, 2011 at http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2011/Jan/Strengthen-Primary-Care.aspx.

21.

McMahon. Coming to America - international medical graduates in the United States. NEJM. 2004;350(24):2435–2437.PubMedCrossRef

22.

Hing E, Lin S. Role of international medical graduates providing office-based medical care: United States, 2005–2006. NCHS data brief. No. 13. Hyattsville: National Center for Health Statistics; 2009 (Accessed September 27, 2011 at http://www.cdc.gov/nchs/data/databriefs/db13.pdf).

23.

Norcini J, Boulet J, Dauphinee W, Opalek A, Krantz I, Anderson S. Evaluating the quality of care provided by graduates of international medical schools. Health Aff. 2010;29(8):1461–1468.CrossRef

24.

Whitcomb ME. New medical schools in the United States. N Engl J Med. 2010;362:1255–1258.PubMedCrossRef

25.

Report to the Congress: Aligning incentives in Medicare. Medicare Payment Advisory Commission, June 2010, Chapter 4, Washington, DC. Accessed September 27, 2011 at: http://www.medpac.gov/documents/Jun10_EntireReport.pdf.

26.

Huang E. Office of the Assistant Secretary of Health for Planning and Evaluation (ASPE), Department of Health and Human Services, Washington. Personal communication: DC; 2011.

27.

GAO Report - Primary care professionals: recent supply trends, projections, and valuation of services. 2008. Accessed September 27, 2011 at: http://www.gao.gov/new.items/d08472t.pdf.

28.

American Academy of Nurse Practitioners, frequently asked questions. Accessed September 27, 2011 at: http://www.aanp.org/NR/rdonlyres/A1D9B4BD-AC5E-45BF-9EB0-DEFCA1123204/4710/2011FAQswhatisanNPupdated.pdf.

29.

Grumbach K, et al. Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Annals of Family Medicine, July/August 2003.

30.

2009–10 AANP National NP Sample Survey: An overview, American Academy of Nurse Practitioners, August 2010. Accessed September 27, 2011 at: http://www.aanp.org/NR/rdonlyres/0952E2EF-CE8F-4B26-AC00-19041F1B8E59/0/OnlineReport_General2.pdf.

31.

Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff. 2009;28(1):64–74.CrossRef

32.

Consensus Report. The future of nursing: leading change, advancing health. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. October 5, 2010, Accessed September 27, 2011 at: http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx.

33.

Paradise J, Dark C, Bitler N. Improving access to adult primary care in Medicaid: exploring the potential role of nurse practitioners and physician sssistants. Kaiser Family Foundation, Issue Paper, March 2011. Accessed September 27, 2011 at: http://www.kff.org/medicaid/upload/8167.pdf.

34.

Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ. 2002;324:819–823.PubMedCrossRef

35.

Laurant M, et al. Substitution of doctors by nurses in primary care (Review), Cochrane Database of Systematic Reviews 2004, Issue 4.

36.

Funkenstein DH. Medical students, medical schools, and society during five eras. Cambridge, MA: Ballinger Publishing Company; 1978.

37.

Schwartz MD, Basco WT, Grey MR, Elmore JG, Rubenstein A. Rekindling student interest in generalist careers. Ann Intern Med. 2005;142:715–724.PubMed

38.

Medical Group Management Association. (2009). Data from physician compensation and production survey. Accessed September 27, 2011 at: http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=29312.

39.

Weiner JP. Forecasting the effects of health care reform on US physician workforce requirements: evidence from HMO staffing patterns. JAMA. 1994;272:222–230.PubMedCrossRef

40.

Hsiao WC, Braun P, Yntema D, Becker ER. Estimating physicians' work for a resource-based relative-value scale. N Engl J Med. 1988;319:835–841.PubMedCrossRef

41.

Bodenheimer T, Berenson RA, Rudolf P. The primary care–specialty income gap: why it matters. Ann Intern Med. 2007;146:301–306.PubMed

42.

American Medical Association RVS Update Committee (RUC). AMA/Specialty Society: RVS Update Process. Accessed September 27, 2011 at: http://www.ama-assn.org/ama1/pub/upload/mm/380/ruc-update-booklet.pdf.

43.

Goodson J. Unintended consequences of resource-based relative value scale reimbursement. JAMA. 2007;298(19):2308–2310.PubMedCrossRef

44.

Sessums S, Moran B, Rich E, Dennis L, Liebow M, eds. Health care advocacy: a guide for busy clinicians. New York: Springer; 2011.

45.

McDonough JE. Inside national health reform, 1st edn. University of California Press; 2011.

46.

Bodenheimer TS, Grumbach K. Understanding health policy: a clinical approach. (Lange Clinical Medicine) McGraw-Hill Medical; 5th edition, 2008.

Title: Health Care Reform and the Primary Care Workforce Bottleneck
Author: Mark D. Schwartz, MD
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 4/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-011-1921-4

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2012

Depression and Anxiety Diagnoses Are Not Associated with Delayed Resolution of Abnormal Mammograms and Pap Tests Among Vulnerable Women

Electronic Risk Alerts to Improve Primary Care Management of Chest Pain: A Randomized, Controlled Trial

The Association Between Personal Health Record Use and Diabetes Quality Measures

From the Editors’ Desk: Improving Performance Through Coaching, Incentives, Feedback, and Practice

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches

Spiritual Assessment in Clinical Setting: The Need for Future Research

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials