Senate Subcommittee Report Underscores Need for More Primary Care Physicians

The growing shortage of primary care physicians has forced millions of Americans to seek care from emergency rooms and to delay or forgo needed care in some instances, which has resulted in higher rates of preventable illnesses and even deaths, according to a new report (14-page PDF; About PDFs) issued by the chair of a Senate subcommittee on primary health and aging.

"When people delay or fail to receive primary care and preventive services, everyone pays the price," says the report, which was issued by Sen. Bernard Sanders, I-Vt., chair of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Health and Aging. "It is not only our moral responsibility to ensure primary care access now and into the future, but it is fiscally sensible to act quickly to expand this critical workforce."

According to the report, the "evidence is clear that access to primary health care results in better health outcomes, reduced health disparities and lower spending, including on avoidable emergency room visits and hospital care. … Primary care is intended to be, and should be, the foundation of the U.S. health care system."

Yet, the shortage of primary care physicians and other primary care health professionals has reached critical mass, says the report. Nearly 57 million people in the United States, or one in five Americans, now live in areas that lack adequate access to primary care. As a consequence, millions of Americans use the emergency room for care that could have been provided by a primary care physician. Specifically, half of emergency room patients could have obtained care from a primary care physician if they had been able to obtain an appointment when care was needed, according to the report.

"Visits to emergency rooms are not only more expensive, but the lack of continuity in care can result in extra tests, limited follow-up care and an increased risk for medical errors," says the report. "Also, acute, nonurgent cases can crowd emergency rooms, making it more challenging for emergency room physicians to provide care to the most serious cases."

The need for primary care physicians will become even more severe as the Patient Protection and Affordable Care Act extends health care coverage to millions more people during the next few years. According to the report, the nation will need 52,000 primary care physicians by 2025, a demand that will not be met based on current trends.

"In 2011, about 17,000 doctors graduated from American medical schools," the report says. "Despite the fact that over half of patient visits are for primary care, only 7 percent of the nation's medical school graduates now choose a primary care career."

Additionally, the average primary care physician in the United States is 47 years old, and one-quarter are nearing retirement, a trend that will further exacerbate the growing shortage.

The report cites other reasons for the growing shortage of primary care physicians, as well, including the wide income disparity between subspecialists and primary care physicians that acts as a disincentive to pursuing primary care.

The report also discusses the AMA/Specialty Society Relative Value Scale Update Committee (RUC). It describes the 31-member committee as dominated by subspecialists and largely responsible for setting physician payment rates. "Therefore, it should come as no surprise that it (the RUC) has accelerated higher payments -- larger paychecks -- to (sub)specialists over primary care doctors," says the report.

Medicare, meanwhile, encourages the growth of subspecialty residencies by providing about $10 billion a year to teaching hospitals "without requiring any emphasis on training primary care doctors. Because of the strong financial incentives to train (sub)specialists, many hospitals have shifted away from training primary care doctors over time," the report says.

There are various ways of addressing the ongoing shortage of primary care physicians and other primary care health professionals, says the report. It recommends increasing primary care scholarship and loan-repayment programs and opportunities in education and residencies for primary care training in community settings. For example, the Affordable Care Act has created the Teaching Health Centers program to move training outside of hospitals and into communities, where most health care is delivered.

The Affordable Care Act provides $230 million for the Teaching Health Centers program from 2011-15, which is a small percentage of overall graduate medical education spending and is enough to produce 600 new primary care residents by 2015, according to the report. "Although these physicians will serve thousands of patients, the scope of the need in this country is so great that this program must be dramatically expanded."