The warnings have been pretty clear – demand for primary care physicians (PCPs) dwarfs supply, and will do so increasingly into the next decade. Further, the physician deficit comes at a time when primary care is playing a much bigger role in population health management and more people are gaining access to health coverage. Clearly, this presents significant implications for health systems seeking to enhance their primary care networks. So what’s the solution? Here are five strategies systems are employing to circumvent the PCP shortage.
Midlevel providers, when effectively integrated into a care delivery system, can bolster patient access while decreasing the need to add new PCPs – or at least buy time to recruit and hire new physicians. The number of midlevel providers is drastically outpacing the PCP supply. From 1996 to 2008, the number of PCPs grew by 29% while nurse practitioners (NPs) and physician assistants (PAs) increased by 123% and 153%, respectively, according to the Atlanta Journal Constitution. If PAs and NPs are effectively integrated and leveraged, a projected shortage of 20,400 physicians in 2020 could be reduced to 6,400 PCPs, according to the Health Services and Resources Administration (HSRA).
Alternate Delivery Models
In light of the limited pool of PCPs, systems are pursuing alternate care models, such as the patient-centered medical home (PCMH). In the team-based approach of the PCMH model, for example, PCPs manage the overall care plans of patients, but midlevel providers and nursing staff take on more of the legwork in care delivery by engaging patients during visits, as well as via telephone and e-mail. So, while many PCMH models require increases in staff, they do not necessarily require more physicians.
When patients are unable to see their PCPs for acute care needs, emergency departments (EDs) and urgent care centers (UCCs) become go-to options. However, EDs are already swamped and unable to keep up with patient demand. It is estimated that 13.7% to 27.1% of all ED visits could be effectively treated at UCCs, or perhaps convenient care clinics, saving health systems approximately $4.4 billion per year. Since 2008, the number of UCCs has grown from 8,000 to about 9,300 sites across the nation to match patient demands. Integrating UCCs into primary care networks can ease the burden on PCPs, allowing them to focus on population health management efforts while satisfying patient demand for ready access to non-emergent, acute care.
The use of technology to provide expanded care services to patients is an increasingly attractive care delivery model for systems feeling the pinch of the PCP shortage. The pervasiveness of technology and the population’s growing fluency with it allows telemedicine, such as e-mail and video conferencing, to be a convenient and highly accessible approach to primary care for providers and patients. More than half of the hospitals in the United States use telemedicine to some extent, according to the American Telemedicine Association. Leveraging technological capabilities through telemedicine can free up the schedules of PCPs by keeping patients out of the doctor’s office, while still efficiently and cost-effectively managing patients’ primary care needs.
Group visits are a growing trend, particularly for patients with similar chronic conditions. A group visit allows PCPs to provide patient education and self-management instructions, while also giving patients the opportunity to engage with other individuals who share their affliction. This can be an effective use of a physician’s time, since it allows for multiple patients to receive care simultaneously. Although most patients will require individual follow-up care, group visits can cut down on the overall number of appointments. Certainly, confidentiality, billing, and operational challenges exist; however, group visits could provide some efficiency in care delivery for systems light on PCPs.
Time to Adapt
The PCP shortage will continue to be an area of great concern for health systems as they seek to keep pace with the demands for primary care. This leaves hospitals and health systems in a position to consider all available options for circumventing the deficit. Those that are successful will proactively pursue innovative strategies, such as those listed above, to mitigate the impact of the PCP shortage on their ability to provide accessible, high-quality primary care.
This post was originally featured on the athenahealth Health Care Leadership Forum – June 20th, 2014.