Expansion of the primary care workforce is necessary to improve the "poor" state of the nation's health care, according to Dr. Jeffrey P. Harris, president of the American College of Physicians.
"We have too many uninsured. We have too few primary care physicians. We spend more for health care and get less in return than most other industrialized countries," Dr. Harris said during the ACP's annual "State of the Nation's Health Care" briefing, which was held in Washington. He noted that "at this same event in 2006, the American College of Physicians warned that primary care was nearing collapse in the United States. Regrettably, primary care is in even more critical condition today than it was just 3 years ago."
Dr. Harris cited a recent report from the Institute of Medicine, which showed that 16,000 additional primary care physicians are needed to meet the current demand in underserved areas. "The primary care shortage is occurring at a time when the need for primary care is greater than ever," he said. "An aging population, with growing incidences of chronic illness, will increase the demand for general internists and other primary care doctors."
The college has found that nations in which primary care physicians make up 50% of the total physician workforce have better outcomes and lower health care costs, according to Dr. Harris. Therefore, "we are calling for the federal government to convene an expert advisory group to recommend specific targets and the numbers and proportion of primary care physicians appropriate for the United States," which has only 30% primary care physicians in its workforce.
Robert B. Doherty, the ACP's senior vice-president of governmental affairs and public policy, outlined steps the college would like to see the government take to increase the number of primary care physicians:
▸ Make primary care compensation competitive with other specialties. "Specifically, a market and price sensitivity analysis should be conducted to set specific benchmarks for improving primary care compensation so that it is competitive with other career and specialty choices," Mr. Doherty said.
For instance, Dr. Harris said that Medicare payment increases of 7.5%-8% per year over 5 years would be needed to bring primary care compensation to 80% of that of all other specialties. Right now, the average compensation of primary care doctors is about 55% that of their non-primary care colleagues. Commercial payers would need to implement comparable increases.
▸ Expand the patient-centered medical home model to more states, more practices, and more patients. "This innovative model of primary care delivery offers enormous potential to improve quality and lower the costs of care, especially for patients with chronic illnesses," Mr. Doherty said.
▸ Conduct a systematic review of the paperwork burdens on primary care doctors that detract from the time they can spend with patients, and that add to physician dissatisfaction.
▸ Increase funding for primary care training programs and create new programs to eliminate medical education debt for internists, family physicians, and pediatricians who agree to provide primary care in a critical shortage area or clinic.
▸ Implement reforms to improve quality and efficiency of care for all patients, including those seen by specialists. This would include revising the Sustainable Growth Rate formula that governs Medicare payments, improving the Physician Quality Reporting Initiative, funding independent research on the comparative effectiveness of different treatments, and helping physicians acquire health information systems, Mr. Doherty said.
The ACP is making one additional request, Mr. Doherty added: President Barack Obama should consider issuing an executive order to "ensure that all federal agencies are working together seamlessly to design, implement, measure, and evaluate programs to increase primary care workforce capacity."
'Regrettably, primary care is in even more critical condition today than it was just 3 years ago.' DR. HARRIS