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Senate Subcommittee Report Underscores Need for More Primary Care Physicians
Report Cites Causes, Effects of Primary Care Shortages
By News Staff
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."
- The growing shortage of primary care physicians has resulted in higher rates of preventable illnesses and even deaths, says a new report released by the chair of a Senate subcommittee on health and aging.
- Without adequate access to primary care services, millions of Americans are forced to seek care from emergency rooms and to delay or even forgo needed care altogether.
- The report makes a compelling case for primary care services, saying they result in better health outcomes, reduced health disparities and lower spending overall.
"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."
Graham Center Report
Reforming GME to Train More Primary Care Physicians Will Require Enforcement
Senate Committee Recognizes Role of Primary Care Physicians