By 2014, the Patient Protection and Affordable Care Act (ACA) will expand
the Medicaid health insurance program to over 15 million people. Among many things,
this expansion will allow millions of people access to regular primary care.
But is the field of primary care prepared to deal with such an expansion?
Primary care physicians (PCP's) serve as the initial contact person for a patient’s health issue. PCP's work with the patient over a long duration of time, treating routine conditions and providing preventive services like vaccinations. PCP's also refer the patient to specialists (e.g. cardiologists, endocrinologists) when necessary. Depending on the scope of the physician’s practice, primary care providers are internists and pediatricians, but can also be geriatricians or obstetricians and gynecologists. Nurse practitioners and physician’s assistants are increasingly providing primary care to patients as well.
Primary care physicians (PCP's) serve as the initial contact person for a patient’s health issue. PCP's work with the patient over a long duration of time, treating routine conditions and providing preventive services like vaccinations. PCP's also refer the patient to specialists (e.g. cardiologists, endocrinologists) when necessary. Depending on the scope of the physician’s practice, primary care providers are internists and pediatricians, but can also be geriatricians or obstetricians and gynecologists. Nurse practitioners and physician’s assistants are increasingly providing primary care to patients as well.
For many years there has been talk about a physician
shortage in the field of primary care. At one time, primary care physicians constituted
the bulk of American physicians. However, advances in technology, increased medical educational debt, lower
reimbursements and higher patient loads for primary care physicians have caused
most doctors in training to enter a specialty field. The Association of American Medical Colleges predicts that in the decade that began in 2010, nearly
one-third of all practicing physicians will retire. As a result, Americans will
need an estimated 45,000 primary care physicians by 2020.
This trend has far-reaching consequences. Many ethnic minorities,
people with low socioeconomic status or no health insurance may use primary care physicians and/or community health centers as their only source of health care; however, access to these providers
is already limited for some patients because of factors like geography and a lack of
transportation, or more complex issues like language barriers. The actual shortage of physicians
and lack of funding for community health centers only exacerbates this problem.
Also, one statistic from the Kaiser Family Foundation says
that 56% of patient visits in America require primary care, but only 37% of
physicians practice primary care medicine, and only 8% of the nation’s medical
school graduates go into family medicine. Furthermore, a higher ratio of
specialists to patients has been correlated with higher mortality rates overall. This
suggests that a higher ratio of primary care physicians will contribute to
better health. With better access to primary care, patients can prevent disease
and receive early treatment in the event of an illness.
The ACA has proposed several pieces of legislation to help
solve the primary care physician shortage (the following was summarized from a
Kaiser Family Foundation brief):
- Add 15,000 new primary care providers to the workforce by 2015
- Allocate $300 million for the National Health Service Corps which recruits the primary care workforce in underserved areas
- $230 million in award grants will go to “teaching health centers” to start primary care residency programs
- 10% bonuses for primary care providers under the Medicare fee schedule (started in 2011)
- Increase PCP reimbursements at the state level from Medicaid rates to Medicare rates by 2014
- Increase the number of Accountable Care Organizations (ACO's) which thrive on the quality and not the quantity of patient care. ACO's encourage collaboration among physicians and allied health professionals rather than overuse of medical services
- Increase the number of community health centers
Lastly, medical education institutions are charged to shape medicine’s leaders of tomorrow. This means medical schools should continue to educate students about issues related to primary care and the state of the health care system. Shadowing and networking with primary care physicians may increase interest in the field. Curricula should include such activities. Also, the number of residency programs must increase in order to accommodate the growing number of medical school graduates.
No comments:
Post a Comment