Within the next two years, the Affordable Care Act (ACA) is poised to expand healthcare coverage to more than 30 million Americans. However, the supply of primary care physicians (PCP) is small and experts estimate that it can’t keep up with the increase in access. The American Academy of Family Physicians estimates that the United States faces a shortage of 60,000 primary care physicians overall by 2020. The problem is compounded by the fact that healthcare researchers are reporting that primary care is directly related to healthcare cost control efforts. IBM conducted a global healthcare study and found that countries with the highest usage of primary care services have the healthiest populations and spend lower per capita on healthcare.
Making primary care a more desirable career path
The primary reason for the shortage of PCPs is simple. PCPs do not earn as much as specialty physicians and have to deal with significant insurance bureaucracy and government scrutiny. A survey of U.S. primary care physicians found that 49% of the respondents would seriously consider getting out of the medical business within the next three years if they had an alternative. Medical students with massive educational debt are also shying away from primary care because of its relatively low pay. Students are more likely to pursue high-paying specialties such as surgery. Some medical schools have taken steps to make a career in primary care more desirable to students. The University of Maryland School of Medicine plans to use a $877,000 grant from the Health Resources and Services Administration to increase interest in primary care specialties among its medical students. Lawmakers have also proposed legislation that would fund primary care training models in nonhospital settings. Physicians who enjoy practicing primary care medicine, but are turned off by the relatively low pay, insurance hassles and other bureaucratic headaches might want to consider working as a locum tenens. Locum tenens physicians can practice primary care medicine as independent contractors, earn competitive pay, and enjoy relative freedom from the paperwork and monotony of a traditional primary care position. Similarly, locum tenens may also be a desirable career path for medical students who are not interested in the typical primary care model. Also, because PCPs are in such high demand, locum tenens physicians have many options when choosing assignments.
Increasing reliance on nurse practitioners
In addition to making primary care more desirable to physicians, the government has enacted initiatives that increase educational funding for other primary care providers, including nurse practitioners (NP). Unlike physicians, NPs are flocking to primary care. According to an issue brief by the Kaiser Commission on Medicaid and the Uninsured, the vast majority of NPs practice in primary care, and they are also the fastest growing segment of the primary care workforce. The number of NPs working in primary care has increased by 9% annually since the mid-1990s. On March 21, The Centers for Medicare & Medicaid Services (CMS) announced an initiative that would provide up to $200 million to hospitals that offer training of advanced practice registered nurses (APRN). CMS plans to select five hospitals to participate in the demonstration program, which is expected to run for four years. NPs are expected to play a critical role in the future of primary care. They are qualified to perform many of the basic primary care services (e.g., diagnosing and treating common ailments) and do so at a lower rate. Demand for NPs in the primary care setting will likely increase as administrators and lawmakers search for ways to handle increased patient populations while controlling costs. This means that locum tenens NPs will be in high demand and will have many assignment options from which to choose.