Radical Changes in Primary Care Needed to Meet Coming Demand for Health Care

Concerned about the coming increase in the number of patients who will need access to a primary care physician, the AAFP is urging the public and private sectors to work on sustaining and strengthening the nation's primary care physician infrastructure. What is needed are policies and programs to support the practice of primary care and increase the supply of primary care physicians, said the AAFP recently in testimony (6-page PDF; About PDFs) submitted to the Senate's Health, Education, Labor and Pensions Subcommittee on Health.

"Health delivery reform requires considering how our dysfunctional health care system can become one that serves the patient by coordinating care over time to prevent disease, managing chronic conditions, and providing immediate and targeted care for an acute condition when it arises," said the AAFP in written testimony. "The availability of an adequate primary care physician workforce is essential to achieving these aims."

The AAFP identified specific steps the public and private sectors could take to increase the number of primary care physicians, and noted that the need to enact such policies is acute because the Patient Protection and Affordable Care Act will extend health care coverage to millions more individuals during the next few years.

The percentage of primary care physicians in the United States needs to increase from the current 32 percent of the physician workforce to at least 40 percent, said the AAFP. "Decreased medical student interest in primary care is caused by multiple factors, including heavy workload, insufficient reimbursement, the subtle persuasion in medical school away from primary care and a lack of strong primary care role models," said the AAFP.

To help boost interest in primary care, the average income of physicians actually practicing primary care must increase to at least 70 percent of the median income of all physicians, an increase of about 20 percent, said the AAFP. "If primary care physicians are paid differently and better, in the context of the physician-led, patient-centered medical home (PCMH), costs should decline."

Medical schools and academic health centers also can take steps to help increase the primary care physician work force by

These institutions also should require student participation in rural, underserved and global health experiences and require block and longitudinal experiences that demonstrate the essential functions of primary care and the PCMH.

Federal and state governments can support an expansion in primary care by providing increased incentives for physicians who practice primary care or other critical specialties in designated health workforce shortage areas and by increasing funding for scholarship, loan, loan repayment and tuition waiver programs to lower financial obligations for students who plan and pursue careers in primary care, said the AAFP. Primary care physicians also should receive preferential increases in fee-for-service payments for primary care.