Friday, January 18, 2013

Conflicting views on the need for more family physicians

Researchers at the American Academy of Family Physicians' Robert Graham Center (which produces the Policy One-Pagers series for American Family Physician) recently predicted in the Annals of Family Medicine that a combination of population growth, aging, and insurance expansion from the Affordable Care Act will create the need for an additional 52,000 primary care physicians by the year 2025 - an increase of nearly 25 percent over the current workforce. Since the vast majority of internal medicine residents plan to pursue subspecialty rather than generalist careers, family medicine will be called on to supply the bulk of this looming gap in physician supply and demand. Recent efforts to increase the supply of family physicians include emphasizing community-based clinical training in medical school and temporarily increasing Medicaid and Medicare primary care fees.

Another strategy for bolstering the family medicine pipeline, contained in the Affordable Care Act, is mandating redistribution of unused residency positions to primary care programs. Unfortunately, an analysis published this month in Health Affairs concluded that a similar Medicare graduate medical education reform in 2005 not only failed to significantly boost primary care, but actually resulted in training twice as many new subspecialists. Dr. Candace Chen and colleagues conclude:

Our findings suggest that redistribution [of unused residency positions] largely supported hospitals in growing their specialty training. Some hospitals even converted primary care positions to specialty positions after receiving newly redistributed positions. ... This shifting collectively perpetuates the nation's physician workforce maldistribution, and our analysis demonstrates that Medicare continues to support these hospitals and even increases its support for them, regardless of the specialty mix of residents trained.

Not everyone agrees that meeting the future health needs of the U.S. population will require a massive influx of family physicians, however. Other researchers have argued that the widespread adoption of team-based care, "advanced access" scheduling, and replacing some in-person with electronic visits could provide enough new patient capacity to prevent a family physician shortage. Still, much uncertainty surrounds this and other projections. What steps is your doctor's practice taking, if any, to meet the anticipated needs of so many new patients? Hiring more physicians? Re-designing how they provide care? Please feel free to share your thoughts and stories.

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The above post first appeared on the AFP Community Blog.

2 comments:

  1. Nice article Kenny, and very timely as my Twitter feed presented this analysis of how team based care and increasing numbers of advanced-practice clinicians can fill the primary care physician shortage: http://www.ama-assn.org/amednews/2013/01/14/gvsd0118.htm#.UPlpO2ywitg.twitter . I agree in team-based care and I know some great APC's, but I fear that following the recommendations of this article will lead to greater health care spending. I am convinced by the evidence that shows that family physicians practicing full spectrum care reduce referrals that would lead to more expensive testing and more procedures without improving the quality of care. I believe that we need to put this data forward as we make the argument that while teams and APCs will help, they are no substitute for well- trained family physicians.

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  2. The United States is in the midst of a physician shortage that is expected to intensify as baby boomers age and the need for health care grows. It is estimated that as many as one-third of today's practicing physicians will retire by 2020. There are about 650,000 practicing physicians of all kinds and a little more than half of those are primary care physicians.

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