Physicians

The Primary Care Workforce: Help is on the Way

The best electronic health record on the planet isn’t going to help anybody unless a physician uses it. The HITECH incentive scheme should enhance the woefully poor EHR uptake rates among US providers, as should innovative vendor business models that remove cost-barriers which have prevented many from getting in the game.

But there’s an even more fundamental issue, which is a looming manpower shortage among the ranks of US primary care physicians, a topic we’ve covered numerous times, most recently here. There simply aren’t enough physicians to use those EHRs!

Communities across the nation have long suffered from a lack of PCPs. The problem is expected to worsen as baby boomers age and the number of medical students who enter primary care continues to drop. If nothing is done to change current trends, the Association of American Medical Colleges estimates our country will be short 21,000 and PCPs in 2015 and a whopping 47,000 in 2025.

Now, finally, something is being done. And while it may not be enough, it certainly points us in the right direction. More importantly, it sets a precedent for future interventions by the federal government.

This Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius announced $250 million worth of new investments designed to support the training and development of more than 16,000 new primary care providers over the next five years. The investments were mandated by the Affordable Care Act, that controversial health care bill signed into law by President Obama in March.

“These new investments will strengthen our primary care workforce to ensure that more Americans can get the quality care they need to stay healthy,” Sebelius said in a press release. “Primary care providers are on the front line in helping Americans stay healthy by preventing disease, treating illness, and helping to manage chronic conditions. These investments build on the Administration’s strong commitment to training the primary care doctors and nurses of tomorrow and improving both health care quality and access for Americans throughout the country.”

According to HHS, the investments will be used as follows:

Creating additional primary care residency slots: $168 million to train 500 new primary care physicians by 2015;

Supporting physician assistant training in primary care: $32 million to train 600 new physician assistants, who practice medicine under the supervision of a physician, and can be trained more quickly than a physician;

Encouraging students to pursue full-time nursing careers: $30 million to encourage 600 nursing students to attend school full-time which will increase the likelihood they complete their education;

Establishing new nurse practitioner-led clinics: $15 million to cover operating expenses for 10 health clinics that help train nurse practitioners. The clinics will be located in medically underserved communities.

Encouraging states to plan for and address health professional workforce needs: $5 million to fund state programs designed to expand their primary care workforce by 10-25% over the next 10 years.

In addition, the Health Resources and Services Administration will direct some federal dollars towards repayment of the loans held by medical school graduates who choose to practice primary care in medically underserved communities. Grants will also be given to community colleges, Hispanic-serving institutions and historically black universities, which were recently ranked as the top producers of primary-care doctors. Students will be able to tap new financial aid, and health professionals working in underserved areas will get expanded tax benefits.

The AAMC’s Atul Grover said the feds’ plan was a laudable, if not altogether comprehensive effort to address the PCP manpower shortage.

“It’s just a small first step, but it’s a step in the right direction,” Grover told the Washington Post.

Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs.  He is a frequent writer for EHR Bloggers, where this post first appeared.

Livongo’s Post Ad Banner 728*90

28
Leave a Reply

28 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
13 Comment authors
pcpAcupunctureMargalit Gur-ArieCHPsmart patient Recent comment authors
newest oldest most voted
Nate
Guest
Nate

If done at the hospital level it would be pretty easy. Use slim networks to make members identify with a specific system. If per member cost is lower then additional payment to the system would be made. Back in the HMO days withholds where common, providers would get say 85% of their payment then based on plan performance or some other criteria all or part of the additonal 15% could be earned. We could increase reimbursements to some new higher amount putting said increase aside. If they improve care and reduce cost or increase inefficency then they get the payment.… Read more »

Merle Bushkin
Guest

Nate, I, too, believe free markets and competition are far more efficient regulators than government, and the engines for innovation. But I also believe government has an important role to play both economically, in guaranteeing a level playing field, and socially, in looking out for the needs of many of our people. But being a pragmatist, I focus on what is doable — and in my opinion the draconian changes to our health care system that you propose simply won’t happen. Thus, I go back to your earlier suggestion that payers might share with providers the cost savings resulting from… Read more »

pcp
Guest
pcp

The fact that Sebelius’s response to the primary care crisis is so grossly inadequate makes this very bad news, not a cause for celebration in any way.

Nate
Guest
Nate

This isn’t going to go over well here but I would say the free market……few minutes for everyone to get over groaning…..I don’t think we can count on government and I don’t know any other way to accomplish it that can’t be gamed. If we had started this 5 years ago I think the system could have afforded to start infreasing reimbursement immediatly while providers worked down waste. Now the financing side can’t afford to pay more while we see if it works. I think it is time for the system to undergo another metamorphisis. When Indemnity stopped working we… Read more »

Merle Bushkin
Guest

Nate, if I understand you correctly, you are suggesting that if physicians (through access to better information from EMRs) could reduce the cost of caring for a patient, insurers could afford to share the savings with the doc by increasing his/her reimbursement rates for the care actually delivered.
This sounds like a great idea but would it work? How would you measure the savings so you’d know how much to pay the doc or hospital?

Nate
Guest
Nate

Hopefully no carriers are reading this, want to know what my employers and myself would really like, For the hospitals and providers to step up and take the risk and get rid of or greatly reduce the role of the insurance companies all togehter. If XYZ hospital could eliminate 30% of their claims by implementing EMR they could offer rates that would blow away any other insurer in the market, with a slim network they would blow away any competing hospitals as well. It would seem any hospital CEO looking to make a killing would embrace EMR instead of running… Read more »

Nate
Guest
Nate

Merle I believe and see redundant or unnecessary tests do in fact cost billions. The estimate that 30% of care might be unnecessary might be high but I am sure it is up there. If we back away from the forest and look at…whats bigger then a foirest? Why are reimbursement rates what they are today? In some asinine display of antilogic it was detwermined that paying less for all test was the best way to control cost. I don’t know many people that think office visits, and a good portion of other reimbursements are over priced. Mose people will… Read more »

Merle Bushkin
Guest

With all due respect to your comments, Nate, I believe you are looking at the trees and missing the forest. Studies done in the past three or four years by McKinsey, Rand and ThomsonReuters, establish that medical errors and redundant or unnecessary tests add several hundred billion dollars to the cost of healthcare in the US. I believe McKinsey in 2006 pegged such costs at $300 billion. Rand subsequently identified a similar amount. Then, in 2009, ThomsonReuters pegged it at $700 billion. The McKinsey and Rand studies established that one third of these costs, or about $100 billion, was due… Read more »

Nate
Guest
Nate

” so let me say that what you have in your database, is information for your current customers, not prospective ones, unless you pay for it.” ? This would be illegal under HIPAA unless people signed a release to give it to me. How does EMR give me claims data on people that aren’t customers? “maybe you don’t need to know anything about folks that wish to buy insurance,” Under the new rules no one is going to need such data. Currently groups over 50 do disclosue forms they don’t collect individual health apps. Even if a small group is… Read more »

Margalit Gur-Arie
Guest

Nate, I wouldn’t want to keep you waiting, so let me say that what you have in your database, is information for your current customers, not prospective ones, unless you pay for it. Since you are not an insurer, maybe you don’t need to know anything about folks that wish to buy insurance, but insurers do. The current claim data is incomplete. You have nothing for things people pay cash with. You have nothing historical from previous payers, unless you pay for it, and most important, you have no information that is not claim related, such as medical history or… Read more »

Acupuncture
Guest

Yes you are right that we must start by basing things on the truth.

Nate
Guest
Nate

Margalit once again you have no idea what you are saying. Are you and Maggie really the same person, she disappears and you pick right up with the crazy baseless comments. “When all data is electronic and computable, insurers can refine their “risk” calculations to improve their financial model” All data is already electronic and computable, I have every ICD9 CPT Rx etc in my database. What additional piece of data that I don’t already have in my database will EMRs add? While I wait for an answer to this I’ll move on as I don’t expect to get one.… Read more »

Margalit Gur-Arie
Guest

Nate, here is how insurers realize profits from EMRs. When all data is electronic and computable, insurers can refine their “risk” calculations to improve their financial model and deny even more claims. Receiving all claims electronically will cut down on manual processing expenses. Better data collection will also help insurers fight real fraud more efficiently, and also imaginary “fraud”. ePrescribing will provide PBMs and payers priceless data for assessing risk. And, BTW, there are no conclusive studies showing exactly how much time docs actually save by using ePrescribing, if any. In addition to that, ePrescribing is “gently” guiding physicians to… Read more »

CHP
Guest

Certainly a step in the right direction, but 500 new PCPs (at $168 million) seems like a tiny dent in the 21,000 doctor shortfall, and an inefficient one at that.

smart patient
Guest
smart patient

Merle has delusions: “so docs benefit from their investment in EMR systems, I strongly doubt they will change the way they keep patient charts.”
There is little benefitof EMR as recently documented in England: They waste time, disrupt the flow of patient conversation, cause mistakes, do not improve outcomes,etc.
The entire program of HITECH has been a boondoggle for the HIT vendors who faked out Congress with inflated and false claims about the devices they are selling. HHS=MMS.