Emerging Care Models May Ease Primary Care Doc Shortage

Marcia Frellick

November 08, 2013

Forecasts that predict dire shortages of primary care physicians have not generally factored in projected changes in the way healthcare is delivered.

David I. Auerbach, a policy researcher with RAND Corporation in Boston, Massachusetts, and colleagues analyzed what the picture might look like with more primary care delivered using 2 emerging models: patient-centered medical homes and nurse-managed health centers. Both models use more nurse practitioners (NPs) and physician assistants (PAs) than traditional models.

Unlike previous projections of physician shortages, the current analysis does not assume that the number of physicians needed is a fixed number and instead considers that improvements such as electronic records and better-coordinated care may reduce the number required, the authors note. Their findings were published in the November issue of Health Affairs.

The researchers found a sharp shift in the primary care provider mix in their projections for 2025. Because of the surge in numbers of NPs and PAs, they project that the percentage of primary care providers who are physicians will shrink from 71% to 60%. NPs would make up 29% and PAs would account for 12%. Although there were nearly 4 primary care physicians for every NP in primary care in 2010, by 2025 that gap will be cut in half, the researchers project, to slightly more than 2 physicians for every NP.

Auerbach and colleagues studied staffing patterns and supply and demand projections in current literature, applied production calculations for provider groups, and gave scenarios under which the primary care physician gap narrows by 2025:

  • "Greater prevalence of medical homes: This scenario assumed that the medical home would provide 45 percent of the nation’s primary care in 2025, growing from 15 percent in 2010." The projected physician shortage would be cut from 45,000 to 35,000. NP surplus: 28,000; PA shortage: 3000.

  • "Greater prevalence of nurse-managed health centers: This scenario assumed that the nurse-managed health center would provide 5 percent of the US primary care in 2025, up from 0.5 percent in 2010." This would reduce the physician gap by roughly the same amount as the first scenario, from 45,000 to 34,000. NP surplus: 19,000; PA surplus: 6000.

  • "Greater prevalence of both: This scenario assumed that the changes in both of the two previous scenarios occurred." The assumption that only half of primary care would be delivered outside of medical homes or nurse-led centers (down from 85%) cut the physician shortage to 24,000. NP surplus: 12,000; PA shortage: 1000.

Because these are projections made amid uncertainty in how healthcare will be delivered as the Affordable Care Act is rolled out, the authors developed an interactive online tool for testing variations in assumptions.

The authors say closing the physician gap may also depend on other changes, such as broader scope-of-practice laws so that NPs and PAs can expand their roles; increasing the number of medical assistants, licensed practical nurses, and aides; and using accountable-care reimbursement models that reward population health management and medical teams, rather than one-on-one physician office visits.

Health Aff. 2013;32:1933-1941. Abstract

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