Physician shortage could be cut by new primary care models, study finds

Much of the shortage of primary care physicians expected over the next decade could be eliminated if the nation increases use of new models of medical care that expand the role of nurse practitioners and physician assistants, according to a new RAND Corporation study.

Expansion of patient-centered medical homes and nurse-managed health centers could help eliminate 50 percent or more of the physician shortage expected to face the U.S. by 2025, according to findings published in the November edition of the journal Health Affairs.

"Growing use of new models of care that depend more on nonphysicians as primary care providers could do much to reduce the nation's looming physician shortage," said David Auerbach, the study's lead author and a policy analyst at RAND, a nonprofit research organization. "But achieving this goal may require changes in policy, such as laws to expand the scope of practice for and physician assistants, and changes in acceptance, on the part of providers and patients, of new models of care."

Forecasts suggest that as more Americans seek health services once they become newly insured under the Affordable Care Act, physician shortages could worsen. Prominent groups have projected shortages of as high as 45,000 physicians by 2025. Those forecasts do not account for changes in how primary care is delivered, however.

Both patient-centered medical homes and nurse-managed health centers are models of primary care that use a mix of medical providers that is richer in nurse practitioners and physician assistants than today's predominant models of delivering .

Medical homes typically use a team-based approach that incorporates physicians, advance practice nurses, physician assistants, pharmacists, nutritionists and other health professionals. They now account for about 15 percent of primary care nationally.

Nurse-managed health centers provide a full range of primary care and some specialty services. They are managed and operated by nurses, with nurse practitioners functioning as the primary care providers. The clinics now account for only 0.5 percent of primary care and typically are affiliated with an academic health center.

If medical homes expand to deliver nearly half of primary care, the nation's expected physician shortage would fall by 25 percent, according to the RAND study. If nurse-managed health centers expand to account for 5 percent of primary care, the doctor shortage would fall by another 25 percent.

Researchers say those growth rates are plausible under the Affordable Care Act. The use of medical homes has been growing rapidly and the Affordable Care Act provides up to $50 million to support nurse-managed .

But there also are obstacles to wider adoption of the approaches, according to the study. State laws may need to be changed to widen the scope-of-practice for both nurse practitioners and physician assistants so they can fill a wider role in primary care.

In addition, there is a need for medical assistants, licensed practical nurses and aides to perform key functions in the new care models, as well as new payment approaches that reward providers for moving to efficient and effective modes of care.

add to favorites email to friend print save as pdf

Related Stories

2012 primary care incentive payments top 664 million

Aug 13, 2013

(HealthDay)—Payments from the Medicare Primary Care Incentive Payment Program (PCIP) were more than $664 million for calendar year 2012, according to a report published by the Centers for Medicare & Medicaid ...

Recommended for you

Moderate alcohol consumption increases attractiveness

32 minutes ago

Consuming alcohol (equivalent to about a glass of wine) can make the drinker appear more attractive than when sober, according to new research from the University of Bristol. However, the effect disappears ...

Teenage TV audiences and energy drink advertisements

3 hours ago

Researchers at Dartmouth College examined a database of television advertisements broadcast between March 2012 and February 2013 on 139 network and cable channels and found that more than 608 hours of advertisements for energy ...

How drinking behavior changes through the years

11 hours ago

In the UK, frequent drinking becomes more common in middle to old age, especially amongst men, according to research published in the open access journal, BMC Medicine. Doctors are seeing a growing number ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.