| Monday, January 01, 0001
As you well know, the healthcare system continues to see a decline in the primary care workforce and patient access to primary care services. A number of factors have combined to contribute to both existing physicians leaving primary care and new doctors electing to practice in specialty medicine. Most prominently, these are: low income compared to specialists; poor work quality due to high patient volumes, long hours and increased mandates on reporting; and – of course – declining and inconsistent reimbursements.
While just over half of patient visits are in primary care, about a third of physicians practice primary care medicine. Most telling, just 1 in 12 med school graduates today choose family medicine. New medical school graduates, saddled with six figure loans, view the primary care work- and lifestyle poorly; they perceive it as requiring greater hours than most specialties – with far less financial reward.
The fee-for-service system, once a fulcrum for revenue and income generation, has evolved to truly hurt primary care physicians – paying less for core and preventative services and far more for specialty procedures and even elective services. The resulting income disparity is dramatic: The typical cardiologist or radiologist makes roughly $400,000 while the typical family physician earns about $175,000.
The net of this trend is bad for the nation. The shortage of primary care doctors contributes to reduced access to care, fragmentation of care, inappropriate use of specialists, and far less emphasis on prevention. A reduced availability of primary care services affects the uninsured, lower income and rural population first – and disproportionately. And, in addition to widening the access gap between lower and upper income Americans, studies show that higher mortality rates exist in areas where the ratio of specialists-to-population is high, while a higher ratio of PCPs-to-population improves overall health.
The shortage is expected to grow – not because of an increase in the rate of physician exodus from primary care but because the Affordable Care Act extends coverage to 16 million more Americans by next year. While the bill attempts to improve access to primary care, in part by paying doctors more for seeing these new patients, Congressional reductions in funding have thwarted that effort. Congress, for example, cut just over $6B from the ACA's $15B Prevention and Public Health Fund, which is slated to cover programs to reduce major cost drivers like smoking and obesity.
In addition, amidst a host of competing budgetary priorities, federal support for physician training is targeted for cuts by both the administration and Congress. In a recent interview with the AARP, Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, called the proposed cuts "catastrophic."
The ACA does include significant initiatives to train a new primary care workforce, increase Medicaid reimbursements and structure more coordinated care. 15,000 new providers are to be added to the system in the next two years. However with the shortage predicted to be several times that number, the ACA's programs effectively plug a few fingers into a bulging dyke.
Sean Hanlon is POR's senior diretor of professional communications. He has held senior marketing, reimbursement management and distribution management positions for diagnostics companies and has managed strategic marketing programs for Boston Scientific, Medtronic, Genentech, Bristol-Myers Squibb and other leading companies. He blogs for POR at blog.physiciansofficeresource.com and can be reached @poronline and @smhanlon on Twitter.