Wednesday, January 26, 2011

Primary care remains a prominent topic

Recently, several articles in high-profile medical journals have discussed the upcoming shortage of primary care physicians in the U.S.:

1) The New England Journal of Medicine published a thoughtful commentary by Representative (and psychiatrist) Jim McDermott from Washington State about the sustainability of the primary care workforce in light of the continuing specter of Medicare payment cuts, rising medical student debt, and low salaries with respect to other physician specialties.

2) Noteworthy, the Family Practice Management blog, summarized the Council on Graduate Medical Education's 20th report to Congress and the Secretary of Health and Human Services, which made five specific policy recommendations to strengthen primary care beyond the modest initiatives contained in the Affordable Care Act.

3) A research article published in Pediatrics highlighted the "profound" geographic maldistribution of clinicians who provide primary care to children in the U.S., where in 2006 the supply of general pediatricians and family physicians relative to the under-18 population was more than six times as high in some areas of the country compared to others.

4) Finally, a New England Journal article published online today examined the enormous magnitude of the challenge facing states whose primary care physician supply is already inadequate to meet the needs of currently insured populations, not to mention the expanded Medicaid-eligible population mandated for coverage by 2014. The authors calculated an "access-challenge index" for each state by dividing the projected Medicaid expansion by the state's primary care capacity. The top 5 most "challenged" states were Oklahoma, Georgia, Texas, Louisiana, and Arkansas. The least challenged were those that already offer their residents universal or near-universal insurance coverage: Massachusetts, Vermont, and the District of Columbia.

It's a positive sign that serious conversations about the pressing primary care shortage, and potential solutions, are continuing even as the House of Representatives seeks to derail the implementation of health reform legislation.