Health Policy$ense

Primary Care Shortages: More Than Just a Head Count

A new LDI/INQRI Research Brief, written by Mark Pauly, PhD, Mary Naylor, RN, PhD, and me, reviews the evidence of an existing or looming primary care shortage in the wake of the ACA. Will the combined effects of an aging population, an increase in coverage and demand for care, and a decrease in the number of physicians going into primary care create widespread gaps in access? Who will treat the newly insured, and will this exacerbate existing workforce shortages? And if shortages become worse, how will they affect how consumers seek care and how health professionals organize to deliver that care?

The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. The Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings.

We conclude that it is unlikely that the influx of patients and the demand for primary care will overwhelm our present capacity, as measured by availability of appointments and wait times.  However, primary care shortages may be felt in certain geographic areas (mostly rural) and perhaps by certain providers, such as federally-qualified health centers, who already provide disproportionate amounts of care to Medicaid and uninsured patients.

In the long run however, the ability to meet increased demands for primary care from an older, more universally insured population will depend on the development of new, more efficient ways of delivering care. The brief points to promising strategies that share one common thread: “top of license” practice (for both physicians and non-physicians) that use health professionals to the full extent of their knowledge and training.  Steps toward this goal can be found in medical homes, retail clinics, and widespread adoption of electronic records.  Planning for that future now--and embracing the most promising strategies that fully utilize non-physician professionals in new systems of care--can avoid primary care shortages even in the long run. 

INQRI (Interdisciplinary Nursing Quality Research Initiative) is a research program, funded by the Robert Wood Johnson Foundation, that quantifies the role of nurses in improving patient care.  Penn’s INQRI program is co-directed by Mary Naylor and Mark Pauly.