Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care—the patient-centered medical home and the nurse-managed health center—both of which use a provider mix that is richer in nurse practitioners and physician assistants than today’s predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and...
#1Clese Erikson(Association of American Medical Colleges)H-Index: 12
Transformations in care delivery and payment models that make care more efficient are leading some to question whether there will really be a shortage of primary care physicians. While it is encouraging to see numerous federal and state policy levers in place to support greater accountability and coordination of care, it is too early to know whether these efforts will change current and future primary care physician workforce needs. More research is needed to inform whether efforts to reduce cos...
Impending physician shortages in the United States will necessitate greater reliance on physician assistants and nurse practitioners, particularly in primary care. But how willing are Americans to accept that change? This study examines provider preferences from patients’ perspective, using data from the Association of American Medical Colleges’ Consumer Survey. We found that about half of the respondents preferred to have a physician as their primary care provider. However, when presented with ...
Purpose: To measure the readiness of rural primary care practices to qualify as patient-centered medical homes (PCMHs), one step toward participating in changes underway in health care finance and delivery. Methods: We used the 2008 Health Tracking Physician Survey to compare PCMH readiness scores among metropolitan and nonmetropolitan primary care practices. The National Committee on Quality Assurance (NCQA) assessment system served as a framework to assess the PCMH capabilities of primary care...
Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients’ ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We used simulation methods to provide estimates of the number of primary care physicians needed,...
PURPOSE We sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act. METHODS In this projection of workforce needs, we used the Medical Expendi- ture Panel Survey to calculate the use of offi ce-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfi le to calculate the number of primary care physicians ...
#1Justin Altschuler(UCSF: University of California, San Francisco)H-Index: 1
#2David Margolius(UCSF: University of California, San Francisco)H-Index: 8
Last. Kevin Grumbach(UCSF: University of California, San Francisco)H-Index: 71
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PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician mem- bers of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive a...
Retail clinics have rapidly become a fixture of the US health care delivery landscape. We studied visits to retail clinics and found that they increased fourfold from 2007 to 2009, with an estimated 5.97 million retail clinic visits in 2009 alone. Compared with retail clinic patients in 2000–06, patients in 2007–09 were more likely to be age sixty-five or older (14.7 percent versus 7.5 percent). Preventive care—in particular, the influenza vaccine—was a larger component of care for patients at r...
Background:The nurse practitioner (NP) workforce has been a focus of considerable policy interest recently, particularly as the Patient Protection and Affordable Care Act may place additional demands on the healthcare professional workforce. The NP workforce has been growing rapidly in recent years,
Many of the U.S. states with the largest anticipated Medicaid expansions are also the ones that have less primary care capacity. These states could face surging demand from the newly insured population without having sufficient primary care resources available.
Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care...
Last. Chivon A. Mingo(GSU: Georgia State University)H-Index: 10
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Efforts to reform primary care increasingly focus on redesigning care in ways that utilize nonprovider staff such as medical assistants (MAs), but the implementation of MA role redesign efforts rem...
Objective This study examined if the variation in physician assistant (PA) state scope of practice (SOP) laws across states are associated with number of employed PAs, PA demographics and PA/population ratio per state. The hypothesis was that less restrictive SOP laws will increase the demand for PAs and the number of PAs in a state. Design Retrospective cross-sectional analysis at three time points: 1998, 2008, 2017. Setting Fifty states and the District of Columbia. Participants Employed PAs i...
Rural Health Clinics (RHCs) were created in 1977 to address the high health care needs, limited provider access, and poor health outcomes of rural Americans. Although innovative at their inception, the provider-centric model of RHC cost-based reimbursement structures has not evolved, leaving limited opportunities for change; many have failed. Comprehensive, proactive change is needed. Registered nurses (RNs) working at the top of their practice scope are a neglected clinical resource that can im...
Last. Angela Nash(University of Texas Health Science Center at Houston)H-Index: 5
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BACKGROUND: The American health care system is facing a growing health care provider shortage in primary and specialty care settings. Research has established that nurse practitioners (NPs) match or exceed their physician colleagues in providing quality care in primary care settings. OBJECTIVE: This systematic review aimed to compare the quality of NP versus physician-led care in outpatient specialty care setting for clinical outcomes patient satisfaction. DATA SOURCES: The Preferred Reporting I...
Importance The Patient Protection and Affordable Care Act (ACA) temporarily increased primary care practitioners’ (PCP) Medicaid fees to that of Medicare for 2013 to 2014 (fee bump) to help accommodate potential increases in demand for care with ACA coverage expansion. This also increased fees for PCPs treating dual-eligible Medicare and Medicaid beneficiaries in many states and eliminated payment differentials for dual-eligible vs non–dual-eligible Medicare beneficiaries that could limit access...
Background: The Physician Associate (PA) role was introduced in Ireland in 2015 in an effort to bolster medical services. From the perspective of the patient and staff they have been well received. However, the attitude of medical students about PAs is not known. Objective: To investigate the willingness of medical students to refer patients to a PA or a doctor. Methods: A quantitative study was undertaken using an online survey with a sample of 1,909 undergraduate and graduate entry medical stu...
The United States (U.S.) workforce is aging. There is a paucity of literature exploring aging nurses’ work ability. This study explored the work-related barriers and facilitators influencing work a...
