The demand for primary care physicians will rise at a steady pace as the U.S. population expands and grows older, meaning state and federal lawmakers should consider options to boost their ranks, according to a recent federal report.
The report from the Congressional Budget Office (CBO),(www.cbo.gov) titled Projecting Demand for the Services of Primary Care Doctors, examines the demand for and value of primary care for the period from 2013 to 2023.
In 2023, demand for services provided by primary care physicians is expected to be 18 percent higher than 2013 levels, largely because of population growth but also due to population aging and gains in insurance coverage. The dollar value of these services is projected to rise from $70.4 billion in 2013 to $83.1 billion in 2023. As a benchmark, the report noted that demand rose 15.5 percent from 2003 to 2013.
The report defined primary care as office services provided by physicians in family medicine, general internal medicine and pediatrics, and the authors noted that their projections are conservative.
- A recent report from the Congressional Budget Office projects that demand for services provided by primary care physicians will increase by 18 percent between 2013 and 2023.
- Most of the report's policy recommendations echo those of the AAFP.
- The report said increasing payments could boost the ranks of primary care physicians, and it suggested a mechanism for doing so.
The report used 2013 as the base year for projections to capture the impact of the Patient Protection and Affordable Care Act (ACA), which put into effect major health insurance provisions the following year. Changes to the ACA would affect those projections.
The report noted that although primary care shortages are acute in rural areas, the U.S. population is growing more rapidly in urban areas, increasing demand there more rapidly.
Demand was also calculated based on age. Surprisingly, per-capita demand for primary care among patients age 65 and older declined between 2003 and 2013, partly because of the very slow growth of Medicare physician payment rates during this period.
"If the federal government increased payment rates for primary care services in Medicare and Medicaid, the compensation of primary care physicians would rise in relation to that of specialists, potentially increasing the number of medical school students and residents who decided to enter primary care," the report stated.
Throughout the report, the authors demonstrate a general awareness of the lack of institutional support to expand primary care, and they suggest solutions. Most of their policy recommendations echo those the AAFP has advocated in recent years.
For example, the authors noted that the ACA requires many unfilled Medicare-funded residency slots at some hospitals to be redirected to primary care or general surgery. In addition, the Veterans Choice, Access and Accountability Act directs the Veterans Health Administration to expand the number of residency positions it supports by as many as 1,500 over the next five years -- primarily in primary care, mental health and other appropriate specialties.
"Further steps like those would help increase the supply of primary care doctors," the authors wrote.
In addition to subsidizing more primary care residencies, the report identified other avenues to expand primary care, such as by expanding loan repayment programs for medical students who choose primary care and making it easier for foreign physicians to practice in the United States. Expanding the number of foreign physicians could be accomplished by exempting them from caps on permanent resident visas or granting them eligibility for those visas if they serve for five years in an underserved area.
"Because training new doctors takes time, shifting the focus of education funding would not change the number of primary care physicians for several years," the report stated. "Loosening restrictions on immigrant doctors would probably affect the workforce more quickly."
Looking to the future, the report said increasing payments could boost the ranks of primary care physicians, and it suggested a mechanism for doing so.
"In the long run, higher prices might also encourage more medical students to enter primary care," the report stated. "Although changes in federal law might be needed to increase Medicare's payment rates for primary care, the prices negotiated by private insurers and the Medicaid fees set by state governments could increase without federal action."
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Report Highlights Need for Better Support for Primary Care