- The US healthcare system is facing a physician shortage, especially in the field of primary care.
- The shortage could impact 44 million Americans, especially those who live in rural areas.
- Part of the problem is that not enough medical students and graduates are choosing to go into the primary care field.
- UnitedHealth Group suggests in a recent report that there might be two ways to extend access to primary care. One is to allow nurse practitioners to practice primary care independently, and the other is through urgent care centers and retail clinics.
The US healthcare system is suffering from a doctor shortage. Of those, primary care physicians are often hit the hardest, posing a huge problem as the country's population grows and ages.
According to a recent report by UnitedHealth Group, 44 million US residents live in a county with a primary care physician shortage. That's 13% of the national population, with residents living in rural areas five times more likely to be impacted by the shortage.
Part of this problem arises from the medical school pipeline - there are simply not enough medical students choosing to go into primary care. In 2017, only 17% of medical school graduates chose a primary care residency program. Although the amount of practicing primary care physicians is expected to increase by 6% in the next seven years, the estimated shortage could still grow from 18,000 to 49,000 in 2030.
UnitedHealth Group's report states that there are two possible ways to expand primary care capacity and access.
The first is to empower and expand practices by Advanced Practice Clinicians who are part of the primary care workforce, and allow them to practice independently. These clinicians include nurse practitioners, physician assistants, and certified nurse midwives.
- Nurse Practitioners: There are currently 204,000 practicing primary care, and they can diagnose and treat health conditions as well as advise on disease prevention and health management. In the US, 28 states limit nurse practitioners from practicing primary care without the supervision of a physician. But if they were allowed to practice independently, the primary care shortage could be reduced from 44 million to fewer than 13 million. Plus, these clinicians are more likely to practice in underserved areas and take on new patients.
- Physician's Assistants: There are currently 33,000 practicing primary care. They can diagnose and treat illness, develop and manage treatment plans, and prescribe medications.
- Certified Nurse Midwives: There are currently 12,000 practicing primary care. Certified to provide many services catered to women's health, they can give assessments, diagnoses, treatments, prenatal care, and help during labor and delivery. They can also improve and extend access especially for women in rural and inner-city areas.
Another way to increase primary care capacity and access to care outside of major hospital systems is through urgent care centers, retail health clinics, and in-home clinical visits.
- Urgent care centers: Equipped to treat a broad range of low to medium-severity illnesses and injuries that require immediate care. There are currently 7,400 centers that are visited by 111 million patient each year.
- Retail clinics: They treat a narrower range of low-severity conditions and are often visited when physician's offices are closed. There are currently 1,800 clinics that are visited by 10 million patient each year.