The Need for More…Primary Care Physicians

Yesterday, the post was about medical homes. An integral part of that strategy is the primary care physician–a role many experts see a shortage of in the near future.

From Newsday, “The General Accountability Office said Tuesday that as of 2006 there were 22,146 American doctors in residency programs in the United States specializing in primary care. That was down from 23,801 in 1995.”

In that same article Senator Bernie Sanders said, “There are simply not enough primary-care providers now and the situation will become far worse in the future unless we do something.”

There may be a multitude of reasons that fewer medical students are choosing primary care as a career path. But I am going to go out on a really fragile limb here: the problem is money, specifically the lack of it.

The role of a primary care physician is extensive, we expect them to be knowledgeable about, well, everything. But we’ve seen specialist reimbursements rise inordinately compared to primary care physicians.

Robert Berenson at Health Affairs Blog writes of the problems being created by Medicare reimbursements for PCPs:

When physicians receive less than 1 percent fee increases year after year, we can expect physicians increasingly to stop seeing Medicare patients, at least those whose clinical expertise does not depend inordinately on the disabled and seniors. Already many PCPs have stopped accepting new Medicare patients, whether or not national surveys have detected the phenomenon. Many physicians who continue to serve Medicare patients are themselves approaching Medicare age and will soon retire, leaving patients without a personal physician and little likelihood that younger physicians will fill the void.

Mr. Berenson continues, “Payment for generalist physicians needs to increase. Payment for niche specialists can safely be reduced, perhaps with a redesigned expenditure target approach. Additional funding sources will need to be found to get out of the SGR budget hole. And there needs to be a process for shifting funds across provider silos.” Mr. Berenson provides good detail on a multitude of topics, I suggest you read it, and not just take my brief summation as the catch-all for the entire post.

The day previous Paul Ginsburg wrote of Medicare reform on the Health Affairs Blog (it’s a series that has a few more posts so stay updated by visiting the Health Affairs Blog), “Primary care physicians are most impacted by the lack of increase in Medicare (and private insurer) payment rates. Physicians in many other specialties can more readily accept declining payment rates because of productivity increases for newer procedures and the ability to increase the number of profitable procedures.” I suggest you read Mr. Ginsburg’s post as well, he lists some potential solutions to the Medicare reimbursement issue(s).

Anyway, we know there is a problem with reimbursement for primary care physicians. Research indicates better medical care if a patient sees a primary care physician when he or she enters the health care system, not to mention cost savings. As always, however, there are varying opinions, and with varying opinions come endless ideas for solutions.