In 2006, the American College of Physicians (2009) cautioned of an eminent collapse of primary care in the United States, which is the cornerstone of the country’s healthcare delivery system. Primary care is the basis of the American healthcare system, and shortage of the primary care providers was highlighted as the major cause of the collapse (ACP, 2008). Various factors have been attributed to the collapse of the primary care in the country, and they include a decline in number of young healthcare professionals joining primary care and a high rate of attrition of primary care providers from the practice. The shortage of primary care providers is occurring at a time when the demand for primary healthcare services is on an upward trajectory in the country due to various factors, including an increasing prevalence of chronic disorders in the population. Additionally, population growth and increasing life expectancy in the population has increased the proportion of elderly persons, who have a high need of healthcare services, due to high prevalence of chronic disorders affecting the group.
The shortage of primary care providers in the United States presents a challenging problem to the country’s healthcare system. By 2030, projections of healthcare staffing in the country indicate that there will be a shortage of about 45,000 primary care providers, mainly physicians (Stuart, 2018). By 2025, it is estimated that the country will require an additional 52, 000 primary care providers (Bodenheimer & Pham, 2013). The demand for primary care providers in the United States will continue increasing because of various factors. These include increasing population, aging and increasing insurance coverage. It is estimated that from 2005 to 2025, the American population will increase by 18% to about 349 million (ACP, 2008). The enactment of Affordable Care Act in the United States also increased the demand for primary care services, because it increased accessibility of healthcare services to low income earners and undeserving populations. It is estimated that about 10, 000 baby boomers becomes eligible for Medicaid every day, once they attain 65 years old. By 2030, it is estimated that over 20 % of the American population will be aged over 65 years and a higher proportion of people aged 85 years (ACP, 2008).
The increased proportion of the aged population has various implications to provisions of primary care services. First it is expected to increase the demand for ambulatory care by about 30% by the 2025 (Mitka, 2017). Secondly, aging population constitutes to a significant proportion of American population affected by chronic disorders. Patients with chronic disorders are the one that utilize the services of offered by primary care providers most, including care coordination and continuity. The demand for primary care services is increased further by the fact that about 45% of the American population suffer from a chronic medical condition, with about 60 million of them having multiple chronic health conditions (ACP, 2008). Although the demand of primary care services continues on an upward trajectory, the number of primary healthcare providers is declining.
Statistical evidence indicates that the number of graduating medical professionals joining primary care is declining. In 2005, it was reported that the number of medical graduates joining family care residence had declined by 50% (Beverly, Reynolds, Balbo, Adkins & Longenecker, 2014). Moreover, a survey examining future career options of fourth year medical students in 2007 indicated that just 2% of them were interested to join primary care, especially internal medicine (Beverly, Reynolds, Balbo, Adkins & Longenecker, 2014). Additionally, women physicians constitute a higher percentage of new medical graduates joining primary care. Research indicates that female physicians work fewer hours than their male counterparts, which implies a further reduction of the available work force. It is estimated that by 2025, female physicians will constitute the entire workforce of primary care providers (Bodenheimer & Pham, 2013). Retention rates of primary care providers in the country also paint a grim picture. Primary care providers report the highest rates of staff turnover. In 2007, about 25 % of board certified physicians in internal medicine left primary care compared to just 5% of other medical specialists (Stuart, 2018).
The shortage of primary care providers in the United States undermines its ability to provide increased access to healthcare services for its population, as envisaged in the affordable care act (ACA). In spite of the critical role that primary care plays in delivery of healthcare services, the United States ranks the lowest among other developed countries in that domain (Bodenheimer & Pham, 2013). This is despite the fact that the country reports highest budgetary expenditure in healthcare spending. High cost of healthcare services has been one of the greatest concerns in the American healthcare system and lowering the cost while improving the quality of healthcare services was one of the main objectives that informed the enactment of the Affordable Care Act (ACA).
Primary care has a high potential of reducing the cost of healthcare in the country in various ways. Empirical studies indicates that states in the country with high proportion of primary care providers reports lower mortality rates from chronic diseases such as heart diseases and cancer (ACP, 2008). Populations with a high ratio of primary care providers report better health outcomes and increased life expectancy compared to those with low ratio (Bodenheimer & Pham, 2013). Additionally, primary care providers provide high quality healthcare services comparable to medical specialists but with minimal expenditure and resources in delivery of healthcare services on ailments such as diabetes. =Although medical specialists are best suited to provide appropriate care to patients with serious or advanced health issues, collaboration between primary care providers with specialists has been found to enhance the health outcomes of such patients. This is attributed to the fact that primary care providers are skilled in developing therapeutic relationship with patients, thus ensuring delivery of patient centered care to the clients from specialists (Bodenheimer & Pham, 2013).
Primary care providers are key players in preventive medicine, which helps in reducing the cost of healthcare. By providing preventive care, primary care providers reduce the rates of hospitalizations, which help in reducing the cost of healthcare. In ambulatory care, research findings indicate that providing quality primary care services reduces the need for hospitalization. Additionally, the ability of primary care providers to implement early interventions help in reducing the severity of health condition, thereby improving the patient outcomes (Mitka, 2017).
The policy on the shortage of primary care providers has various benefits. First the shortage of primary care providers has created opportunities for advanced practice registered nurses (APRNs) and physician assistants to engage fully in the delivery of healthcare services across the population and bridge the gap caused by the shortage. Advanced practice registered nurses have requisite skills and training to deliver specialized healthcare services in primary care. These include prescription of drugs, including the regulated medications, assessment of patient healthcare needs and ordering of medical tests. Additionally, nurse practitioners provide specialized services regarding management and treatment of various health conditions, including chronic diseases.
The report by the Institute of Medicine (2011) concerning the future of nursing highlighted various recommendations that would enhance the capacity of nursing practice to cope with the emerging healthcare needs of the population. One of the recommendations was enabling nurses to practice to their full extent of their, education, training and experience(IOM, 2011). Enabling nurse practitioners practice to their full capability of their education and training in delivery of healthcare services has been a major issue informing various policy changes across diverse states in the United States.
To enable nurses practice to their full extent of their competence, removal of regulatory barriers in different states has been identified as a necessary undertaking. Following the removal of the regulatory constraints, there has been an increased involvement of nurse practitioners in delivery of primary healthcare services. In fact it is estimated that nurse practitioners will cover over 40% of the expected shortage of primary care providers by 2030 (Stuart, 2018).
The other benefit of the policy concerning the shortage of primary care providers is that it has accelerated the adoption of information technology in the delivery of healthcare services. The use of various technological applications, such as telehealth, information technology and electronic health records has facilitated the ability of patients to access patient centered primary care services remotely. Empirical research evidence indicates that the shortage of primary health care providers has been accompanied by an increased application of technology in the American population. The increased application of technology is expected to persist and even increase in future, following the anticipated shortage of primary healthcare providers and increased demand for healthcare services (Bodenheimer & Pham, 2013).
However, the policy on shortage of primary care providers is associated with various shortcomings. These includes cost implications, especially in provisions of necessary resources to encourage medical students join primary care services. Research findings indicates that lack of financial incentives as one of the factors that discourage medical graduates from entering primary care practice, preferring medical careers as specialists. The cost implications undermine the fundamental objective of affordable care act, which aims at enhancing the quality of healthcare services without increasing the costs of healthcare (Green, Sergei & Lu, 2013).
My personal views concerning the policy on the shortage of primary care providers is that it would help in increasing the number of nurse practitioners in the healthcare system as the need for healthcare continues. Secondly, it would encourage more states to remove regulatory barriers limiting nurses to practice fully to the extent of their education and training. Additionally, the policy enhances the uptake of technology in healthcare, which could promote efficiency in delivery of care and minimize the cost of healthcare. However, increased involvement of nurse practitioners in primary care does not in any way undermine the role of physicians, but it creates more opportunities for interdisciplinary collaboration among the various healthcare professionals to enhance quality of healthcare and the ultimate patient outcomes.
American College of Physicians. (2009). How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care? Philadelphia: American College of Physicians: White Paper. Available from 8.pdf
Bodenheimer T., & Pham, H.(2013). Primary care: current problems and proposed solutions. Health Affairs, 29:799-805.
Beverly, E., Reynolds,S., Balbo , J., Adkins S, & Longenecker R.(2014). Changing first-year medical students’ attitudes toward primary care. Family Medicione; 46:707-712.
Green, L., Sergei , S., & Lu, Y.(2013). Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication. Health Affairs, 32(1):1-9.
IOM (Institute of Medicine). (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.
Mitka, M.(2017). Looming shortage of physicians raises concerns about access to care. JAMA, 297(10):1045–1046
Stuart, H. ( 2018, January 1). Shortage of primary care providers driving key medical trends. MD News. Retrieved from http://mdnews.com/shortage-primary-care-providers-driving-key- medical-trends.