Opinion | Supply Chain Problem for Primary Care

In a recent column, I wrote about the decline of traditional primary care delivery in the U.S. I focused on the disruptive changes we’re seeing in primary care delivery models – chiefly the emergence of integrated care organizations and the increasing “Big Box Store” presence in the healthcare sector. This month, I’ll take a deeper dive into what many see as a far more serious problem – the accelerating shortage of primary care providers nationwide.

The health of our population is heavily dependent on having sufficient numbers and types of physicians. Unfortunately, the long-predicted physician shortage is the current reality and, since it takes a minimum of 7 years (4 years of medical school and 3 years of residency) to adequately educate and train a physician, we are well behind the eight ball.

Last year, the Association of American Medical Colleges issued a stunning report on “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034,” which assessed the capacity of the U.S. physician workforce. The authors projected that physician demand will continue to grow faster than supply, resulting in a shortage of 37,000 to 120,000 physicians by 2034. Of particular concern, the report estimated a primary care physician shortage of 17,800 to 48,000 by that same year.

Primary care is vital to the health of the population, and a primary care physician (PCP) shortage will have a profound impact on the quality of care and patient health outcomes.

Our aging population is the major driver of an increasing demand for physicians, particularly PCPs. By 2034, the population of Americans age 65 and over is projected to grow by 42.4%; even greater growth (74%) is anticipated in the population of those age 75 and older. The PCP shortage will inevitably lead to reductions in routine checkups, chronic condition management, and preventive screenings, as well as compromising continuity of care. This will put our communities at greater risk in terms of health and life expectancy.

The “doctor drain” has been with us for some time, but the enormous physical and emotional burden of the pandemic may have exacerbated the problem. With stress levels increasing, physician burnout seems to be on the rise. In addition, a large portion of the physician workforce is nearing the typical retirement age.

So, what can be done to stem the flow? Obviously, it will take more than a single solution; a few that come to mind are:

• Increase efforts to address physician burnout, e.g. mental healthcare
• Reduce administrative burdens imposed by governmental agencies and commercial insurers, e.g. uniform metrics reporting and streamlined processes.
• Increase the supply of primary care advanced practice registered nurses and physician associates
• Extend and enhance reimbursements for telehealth visits
• Provide technological support and training
• Give PCPs access to leadership training – a skill that has proven helpful in improving teamwork

I was also pleased to learn that the issue has captured the attention of Congress. The bipartisan Resident Physician Shortage Reduction Act of 2023, introduced on March 29th, would gradually expand the number of Medicare-supported medical residency positions by 14,000 over 7 years.

My personal experience with the PCP shortage has made me keenly aware of its consequences for individual patients. My wife (a physician and retired managed care executive) and I were lucky enough to acquire a second home in Florida for the winter months. Being familiar with the idiosyncrasies of healthcare system and adequately insured, we embarked on a search for a primary care doctor who was trained in the U.S., had admitting privileges at a quality hospital, and accepted new patients.

Even with both of us doing the research, it took a year to find one – the most junior partner (younger than our children) in a practice that had no online presence and communicated solely by phone. The only alternative was a concierge practice at $5,000 per person annually!

Many seniors continue to be drawn to Florida for its warm weather and relative affordability. How and where will they find the healthcare they need in Florida and in a growing number of states that are impacted by the physician shortage?