1 of 24

AUDREY HEMBREE

Current Healthcare Issue: Primary Care Physician Sortage

INDIANA UNIVERSITY FORT WAYNE

H320: HEALTH SYSTEMS ADMINISTRATION

DECEMBER 4, 2023

2 of 24

WHAT IS A PHYSICIAN SHORTAGE?

WHY IS IT AN ISSUE?

THE ISSUE “IN ACTION”

BACKGROUND ON THE ISSUE

3 of 24

DEFINING THE PHYSICIAN SHORTAGE

PHYSICIAN SHORTAGES OCCUR WHEN THERE ARE NOT ENOUGH PHYSICIANS TO MEET PATIENT DEMANDS

Having less than 80% of the number of physicians that are needed to effectively provide medical care to all patients that are in need of it

Physician shortages are measured by the difference between the demand for physicians and the supply of them

Zhang et al., 2020

Heath, 2019

4 of 24

BACKGROUND ON THE ISSUE

WHY IS IT AN ISSUE?

THE ISSUE “IN ACTION”

WHAT IS A PHYSICIAN SHORTAGE?

5 of 24

BACKGROUND: HOW LONG HAS THIS BEEN SEEN AS AN ISSUE

1960-1970

    • People were worried that a shortage of primary care doctors would be an issue in the future
      • Due to supply of healthcare workers was rising, while the number of underserved people also rising

EARLY 2000

    • 2005 AAMC projection
      • Predicted a shortage of nearly 43,00 to 121,000 physicians overall by 2030
      • Over one-third of the shortage is projected to be among primary care

​

Weiner, 2002

Orr, 2020

2011

    • HRSA reported a deficiency of over 17,000 primary care physicians in the United States

6 of 24

2016

    • The US Department of Health and Human Services reported that over 40% of the population's primary care needs were not being met
      • an area considered to have a shortage if there was one physician for every 3,000 or more people
    • Shortages seen most in rural areas and small communities
      • Still, nearly 65 million people live in “primary care deserts”

Ballotpedia, n.d.

Court, 2016

Zhang et al., 2020

7 of 24

2017

    • A grading scale was developed and applied to physician shortages to evaluate them
      • C ranking was considered average

2020-2021

    • COVID-19 contributes to the issue
      • AAMC report projects a shortage of 17,800 - 48,000 physicians
    • Primary care practices were facing financial challenges during the pandemic
    • 17% of deaths of healthcare workers during the pandemic were physicians
    • Racial and social issues negatively impacted physicians of color and female physicians during this time

​

Zhang, 2020

Dill, 2021

​

8 of 24

2023

    • A survey released showed from the pandemic showed-
        • 1 in 5 physicians plan to leave medicine in the next 2 years
        • 1 in 3 plan to cut hours
    • Nearly 83 million people in the United States now live in areas without proper access to a primary care physician
    • Less than 12% of medical students are choosing primary care
    • Still predicting a shortage of of up to 48,00 primary care physicians

Appleby & Andrews, 2023

Howley, 2022

AMA, 2023

9 of 24

BURNOUT

Burnout scores hit 79% as of 2022

1/5 of PCP’s report planning to leave their position within 2 years

​

BACKGROUND: WHAT IS CAUSING THE SHORTAGE IN PRIMARY CARE PHYSICIANS

LOWER SALARIES

Physicians specializing in other areas make considerably more than those in primary care

One cause is reimbursment rates- most PCP’s can no longer afford to have a private practice

WORKLOAD

Many PCP’s spend 2 hours charting for every one patient

Work 50-60 hour work weeks and end up taking work home at night

STUDENT DEBT

On average PCP’s will have over $200,000 in Medical School debt

Not including debt from undergrad

Grinspoon, 2022

Rosenthal, 2023

10 of 24

11 of 24

WHY IS IT AN ISSUE?

BACKGROUND ON THE ISSUE

THE ISSUE “IN ACTION”

WHAT IS A PHYSICIAN SHORTAGE?

12 of 24

WHY IS THIS AN ISSUE?

Over 80 million people in us dont have access to a primary care physician

Extended wait times to see PCP’s are becoming an issue for those with access to care

A decrease in preventative care leading to poor health outcome

    • Routine Checkups
    • Preventitive Screenings
    • Chronic Condition Management

PRIMARY CARE IS VITAL TO THE HEALTH OF THE POPULATION AND NOT ENOUGH PEOPLE HAVE ACCESS TO IT. THIS WILL LEAD TO POORER HEALTH OUTCOMES FOR THE POPULATION

Nash, 2023

AMA, 2023

13 of 24

THE ISSUE

“IN ACTION”

BACKGROUND ON THE ISSUE

WHY IS IT AN ISSUE?

WHAT IS A PHYSICIAN SHORTAGE?

14 of 24

REAL WORLD EXAMPLE OF THE

ISSUE “IN ACTION”

Background: Allan is a 56 year old male, and lives in a rural area in North Carolina where the nearest primary care doctor is in a town almost 2 hours away so he doesn't get routine checkups.

Issue: Allan develops an irritating cough and he decides to tough it out instead of seeing a doctor because the nearest one is so far away and the soonest appointment he could get was over a month away.

As the months pass Allan's cough is continuously worsening and Allan is eventually rushed to the nearest hospital.

After being examined and having tests ran he finds out that he has advanced lung cancer.

Had he not delayed care due to not having access to a primary care doctor his cancer could have been caught earlier and treated before it developed into an advanced stage.

​

​

​

15 of 24

WHAT IS BEING DONE ABOUT THE ISSUE?

WHAT SHOULD BE DONE TO ADDRESS THIS ISSUE?

WHO ARE THE STAKEHOLDERS?

16 of 24

WHAT IS BEING DONE IN THE PRESENT

IMPROVING SENIORS TIMELY ACCESS TO CARE ACT

Received in Senate in September 2022

Would simplify prior authorization. Aims to reduce the administrative burdens on physicians

​

STRENGTHENING MEDICARE FOR PATIENTS AND PROVIDERS ACT

Introduced to Congress in April 2023

Adjust medicare payment rates to account for inflation. Aims to provide PCPs with financial support

​

CONRAD STATE 30 & PHYSICIANS ACCESS REAUTHORIZATION ACT

Currently sitting in the House in 2023

Authorize and strengthen the Conrad State 30 program for 3 years. Aims to provide incentives to foreign physicians to come practice in the United States in underserved and Rural communities

AMA, 2023

17 of 24

WHAT IS BEING DONE IN THE PRESENT

RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2023

Introduced to House in 2023

Aims to increase the number of residency positions available in areas where there are health professional shortages. Also requires Government Accountability Office to report their strategies for increasing number of healthcare professionals, specifically in rural and underserved communities

AMA, 2023

EXPANSION OF TELEHEALTH TO MAKE UP FOR THE LACK OF PCP’S

Telehealth is expanding and allows people the ability to see a doctor without leaving their home and without having to experience longer wait times to get into see their primary care doctor

MAKING UP FOR THE GAP WITH NP’S AND PA’S

Nurse Practitioners and Physician Assistants are trying to fill the gap

18 of 24

WHATS BEEN DONE IN THE PAST?

RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2009

Was intended to ammend the Social Security Act to provide additional residency poitions but was not passed

ENDED THE MEDICAL SCHOOL MORATORIUM IN 2005

The moratorium called for a reduction/ freeze on medical school enrollments because people were worried that there were going to be to many physicians

PHYSICIAN SHORTAGE GME CAP FLECT ACT OF 2020

Aimed to expand federal funding for residency programs and increase number of residency positions available but was not passed

AMA, 2023

19 of 24

WHO ARE THE STAKEHOLDERS?

WHAT SHOULD BE DONE TO ADDRESS THIS ISSUE?

WHAT IS BEING DONE ABOUT THIS ISSUE?

20 of 24

STAKEHOLDERS

HEALTHCARE SYSTEMS

POLICY MAKERS

MEDICAL SCHOOLS

PATIENTS

PRIMARY CARE PHYSICIANS

21 of 24

WHAT SHOULD BE DONE TO ADDRESS THIS ISSUE?

WHO ARE THE STAKEHOLDERS?

WHAT IS BEING DONE ABOUT THIS ISSUE?

22 of 24

CHANGES THAT SHOULD BE MADE

INCREASE MEDICAL SCHOOL ENROLMENTS

In order to increase the amount of trained physicians in the United States

INCREASE PRIMARY CARE PHYSICIANS REIMBURSEMENT RATES

Will help increase PCP’s salaries and make it more financially posible for them to afford to keep their own practices

CONTINUE TO PROMOTE TELEHEALTH

If patients can’t access their PCP they can still see a Doctor through telehealth when they are ill

23 of 24

RESOURCES

ASSOCIATION OF AMERICAN MEDICAL COLLEGES (AAMC)

AAMC conducts research and provides reports on medical education, including information on the physician workforce and potential solutions to shortages

AMERICAN ACADEMY OF FAMILY PHYSICIANS (AAFP)

AAFP provides insights into challenges facing primary care physicians

THE ROBERT GRAHAM CENTER

The Robert Graham Center focuses on policy research related to family medicine and primary care workforce issue

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

HRSA provides data and resources on healthcare workforce trends, including information specific to primary care shortages

24 of 24

THANK YOU!

Zhang, X., Lin, D., Pforsich, H., & Lin, V. W. (2020, February 6). Physician workforce in the United States of America: Forecasting nationwide shortages. Human resources for health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006215/

Sara Heath. (2019, June 28). Understanding physician shortage issues, patient care access. PatientEngagementHIT. https://patientengagementhit.com/news/understanding-physician-shortage-issues-patient-care-access

Weiner, J. P. (2002). A Shortage Of Physicians Or A Surplus Of Assumptions?. Health Affairs, 21(1), 160. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.21.1.160

Orr, R. (2020, September 8). The planning of U.S. physician shortages - niskanen center. Niskanen Center - Improving Policy, Advancing Moderation. https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/

Physician shortage in the United States. Ballotpedia. (n.d.). https://ballotpedia.org/Physician_shortage_in_the_United_States#:~:text=In%20healthcare%2C%20a%20physician%20shortage,assessments%20of%20the%20physician%20workforce.

Court, E. (2016, April 4). America’s facing a shortage of primary-care doctors. MarketWatch. https://www.marketwatch.com/story/americas-1-million-doctor-shortage-is-right-upon-us-2016-04-01

Dill, M. (2021, June 17). We already needed more doctors. then COVID-19 hit. AAMC. https://www.aamc.org/news/we-already-needed-more-doctors-then-covid-19-hit

Appleby, J., & Andrews, M. (2023, July 5). Will the doctor see you now? maybe not amid the changing health care landscape in the US. USA Today. https://www.usatoday.com/story/news/nation/2023/06/27/primary-care-doctor-shortages-on-the-rise-in-the-us-as-wait-times-grow/70352744007/

Howley, E. K. (2022, July 25). There’s a physician shortage in the U.S. here’s why. Time. https://time.com/6199666/physician-shortage-challenges-solutions/

AMA president sounds alarm on national physician shortage. American Medical Association. (2023, October 25). https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage

Grinspoon, P. (2022a, September 28). Why is it so challenging to find a primary care physician?. Harvard Health. https://www.health.harvard.edu/blog/why-is-it-so-challenging-to-find-a-primary-care-physician-202209282822

Rosenthal, E. (2023, September 8). The shrinking number of primary care physicians is reaching a tipping point. KFF Health News. https://kffhealthnews.org/news/article/lack-of-primary-care-tipping-point/

Nash, D. (2023, May 30). Opinion: Supply chain problem for primary care. Medpage Today. https://www.medpagetoday.com/opinion/focusonpolicy/104744

​

​

References