U.S. Experiencing Primary Care Shortage ‘Likes of Which We Have Not Seen’
Workforce Solutions Proposed to House Health Subcommittee By President of American College of Physicians
March 24, 2009
Washington – “The United States is experiencing a primary care shortage the likes of which we have not seen,” Jeffrey P. Harris, MD, FACP, president of the American College of Physicians (ACP), today told the House of Representatives Energy & Commerce Health Subcommittee. “The demand for primary care in the U.S. will grow exponentially as the nation’s supply of primary care dwindles.”
The reasons behind the decline in the supply of primary care physicians are multi-faceted and complex, Dr. Harris added. They include the rapid rise in medical education debt, decreased income potential for primary care physicians, failed payment policies, and increased burdens associated with the practice of primary care.
Testifying at a hearing, Making Health Care Work for American Families: Improving Access to Care, Dr. Harris told Congress that ACP strongly supports the need to ensure all Americans have access to affordable health coverage. As more people are covered, he said, the primary care workforce needs to grow to take on more patients.”
“Primary care physicians are the first line of contact for individuals newly entering the health care system,” Dr. Harris said. “If we do not increase the primary care workforce, it will become impossible in many communities for people who do not currently have a relationship with a primary care physician to find an internist, family physician or pediatrician who is taking new patients.”
“Noting that decades of research have shown that primary care is the best medicine for better health care and lower costs," Dr. Harris said ACP believes that the United States needs a comprehensive approach to ensure access to primary care. “We should start with a national health care workforce policy process to set specific goals for educating and training a supply of health professionals, including primary care, to meet the nation’s health care needs.”
ACP believes the U.S. needs three other workforce initiatives:
Fund programs to cover the costs of medical education for students who agree to pursue careers in primary care and subsequently practice in areas of the nation with greatest need;
Reform Medicare payment policies. The career choices of medical students and young physicians should be largely unaffected by considerations of differences in earnings expectations, yet Medicare payment policies systematically undervalue the comprehensive, longitudinal, preventive and coordinated care that is the hallmark of primary care;
Currently, the average primary care physician earns approximately 55 percent of the average earnings for all other non-primary care physician specialties.
Studies show that this compensation gap is among the most significant reasons for the growing shortage of primary care physicians.
“Although it may appear to some that our call to increase Medicare payments to primary care is self-serving,” Dr. Harris pointed out, “the fact is that almost half of ACP’s membership practice in subspecialties, not general internal medicine. Yet they share our belief that having a sufficient primary care workforce is essential if patients are to have access to high quality, effective and affordable care.”
Align incentives for accountable, coordinated and patient-centered care, including continued expansion of the Patient-Centered Medical Home as a payment model. The Commonwealth Fund’s Commission on a High Performing Health Care System recently issued a report that advocates that the federal government “strengthen and reinforce patient-centered primary care through enhanced payment of primary care services and changing the way we pay for primary care to encourage the adoption of the medical home model to ensure better access, coordination, chronic care management, and disease prevention.” The report estimates that widespread implementation of the medical home model would reduce national health care expenditures by $175 billion over ten years.
“The United States faces a critical shortage of primary care physicians for adults,” Dr. Harris concluded. “We believe that it is imperative that all Americans be provided with access to affordable coverage. We also know that coverage alone will not ensure that patients have access to high quality and affordable care if there are not primary care physicians available to meet their needs.”
Dr. Harris's testimony is available online.
The American College of Physicians is the nation's largest medical specialty organization. Membership is composed of 126,000 internal medicine physicians (internists) and medical students. Internists provide the majority of health care to adults in America. Internists are specialists in adult medicine and provide comprehensive care to adult patients.