Primary Care: Proposed Solutions to the Physician Shortage Without Training More Physicians

Dr. Thomas S. Bodenheimer, UCSF, and Dr. Mark D. Smith, CHCF

This Health Affairs article by Bodenheimer and Smith examines the primary care physician shortage and how health care organizations can increase capacity and meet patient demand by expanding other clinical roles.

November 2013
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As demand for adult health care services surges, the number of primary care physicians entering medicine continues to decrease, with shortages predicted to reach as high as 40,000 to 52,000 over the next decade. Recruiting new physicians is a logical solution, but one that won't close the care gap anytime soon.

In a CHCF-supported analysis and commentary published in the journal Health Affairs, physicians Thomas Bodenheimer and Mark Smith explore the causes underlying this imbalance in the supply and demand of primary care services, which include aging baby boomers, a rise in chronic conditions, insurance expansion, and dissatisfied physicians leaving their practices.

The analysis also reveals several ways hospitals and physician organizations can increase patient care capacity without adding physicians. Among the recommendations:

  • The crisis is not only a physician workforce shortage, but also a demand-capacity mismatch. Primary care practices can increase capacity without a major recruitment campaign by reassigning responsibilities. This includes empowering licensed personnel, such as registered nurses and pharmacists, to assist patients with behavior change and medication adherence for chronic conditions.
  • Nonlicensed personnel are similarly underused. Expanding the roles of medical assistants to include health coaching and patient panel management could address many preventive and chronic care needs.

The authors note that the potential for patient self-care should also not be overlooked. Finally, they point out, sharing care among nonlicensed team members works only if there is an established plan with standing orders to provide needed services.

Thomas Bodenheimer, MD, is an adjunct professor of family and community medicine at the University of California, San Francisco, and Mark Smith, MD, MBA, is founding president and CEO of the California Health Care Foundation and a member of the clinical faculty at the University of California, San Francisco.

The full article is available at no charge through the External Link below.