The Looming Squeeze On Providers

Substitute “physician assistant” or “pharmacist” for the phrase “the doctor will see you now.” This may become a commonplace introduction patients seeking medical care will hear in the future.

Why is that?

Legislatures throughout our nation are looking for ways to bridge a looming shortage of doctors caused by the approaching exodus of aging physicians and the increased demand for access to physician-led care by millions of newly-insured Americans, courtesy of the federal Patient Protection and Affordable Care Act enacted in 2010. 

Nationally, nearly one quarter (24.7%) of active physicians are age 60 or older.  It’s worse in California where nearly one-third (29.2%) of all active physicians are over 60.  

And depending on which analysts’ projections one uses, starting next year, the ACA is expected to extend either Medicaid or private health insurance coverage to between 24 and 34 million uninsured Americans—including about 4 million of California’s 7 million uninsured residents. All of them will be seeking medical homes with primary care practitioners.

What do we do when increased demand further strains our diminishing supply of doctors? Currently, the average wait time for a new patient to see a doctor is 20.5 days. In Boston – where a form of healthcare reform similar to the ACA was signed into law several years ago – the wait time is nearly 50 days.   So, where do we come up with the 17,000 additional physicians in California many experts say are needed after the ACA kicks in?  

Some approaches worth considering include the following:

• Authorize advance practice nurses, pharmacists, physician assistants, optometrists and other allied health professionals to perform as primary care practitioners to the extent their training and scopes of practice credentials allow.

• Restructure medical education to reduce the debt burden incurred by students who pursue medical degrees. Although physician pay is fairly predictable and unemployment is rarely heard of, many still require decades to pay back their loans. Additionally, the definition of “underserved areas” that are pegged to federal loan forgiveness programs for new doctors could be expanded.

• Identify kids in primary and secondary schools with aptitudes for clinical science and channel them to educational and career opportunities in medicine and allied health professions.

• Increase tax-supported tuition subsidies for students who want to become primary care practitioners.

• Supercharge the payment incentives in the ACA for primary care.

• Congress must also act to preserve the existing financial support provided to those hospitals that help train our future doctors.  Failure to do so will pull the rug out from under many of our nation’s physician training programs.

In California, some state agencies have been making efforts to expand the workforce of nurse practitioners and physician assistants. The Brown-Song program, administered by the Office of Statewide Health Planning and Development, has provided nearly $10 million since 2011 to fund extra slots in family practice residency and nurse practitioner and physician assistant training programs.

Although that is a lot of money, the funds have been parceled out to dozens of schools throughout the state, meaning that just a handful of new slots per program are being added. And many of these programs have shrunk because of prior funding cuts due to the state’s recent budget crises.

Far more will have to be done very soon to ensure patients see a doctor – or someone else qualified to provide them with care. 

Jim Lott is the executive vice president of the Hospital Association of Southern California.