Roosevelt Institute | Cornell University

The Impact of the Shortage of Primary Care Physicians on the American Healthcare System

By Rebecca ShohetPublished September 21, 2015

The shortage of primary care physicians is an issue that can prove immensely detrimental to the near future of our American healthcare system. As our population now lives longer, the number of sick people in the U.S will grow at a faster rate than the matriculation of new doctors into the health system. The Affordable Care Act also puts a strain on primary care doctors as they now have more patients to see. Numerous policy recommendations such as increasing responsibilities for nurses to lift the burden off physicians and improving technologies can be implemented to help solve the primary care physician shortage.

The number of primary care physicians has been on a steady decline in recent years. Interestingly enough, as this number continues to decrease, the demand for primary care services is anticipated to increase in the coming years for two main reasons. Firstly, primary care physicians must treat the continuously growing population, especially the aging population as people are now living longer. Living longer comes with its downfalls as older adults are at high risk for developing chronic illnesses such as diabetes, arthritis, hypertension, and dementia. Secondly, the increased insurance coverage recently introduced by President Obama's Affordable Care Act also proves detrimental to the ratio of physicians per patients as more people now have access to insurance and can now see doctors.

    While the number of sick people seeing physicians is increasing, the number of doctors available to treat them is remaining relatively stagnant. The Association of American Medical Colleges (AAMC) has openly spoken about this dire trend and has continuously said that the number of doctors will continue to decline even further in the coming years. Although the supply of doctors will of course increase in the next few years just as it has been in the last few decades, it will not be enough to combat the physician shortage that is to come. Studies by the Annals of Family Medicine show that the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. This increase in the number of office visits will directly highlight the shortage of physicians, which is estimated to be around 20,400 primary care physicians by the year 2020.  By 2025, the United States could be short between 46,000 and 90,000 physicians overall by that time.

    Family physicians, pediatricians and internists are especially needed as the healthcare industry has recently began a shift from a fee-for-service payments method, which compensates physicians for each service they deliver, to accountable care organizations imposed by the Accountable Care Act, which stresses accountability for the cost and quality of care delivered to patients. Transitioning to value- based health systems is difficult enough, but the situation can be even further complicated if there is a concurrent physician shortage.

    A number of policy recommendations have been suggested to tackle this issue.

Firstly, we should continue to improve upon the methods by which primary care is delivered, including improving current medicine and introducing new medical technologies such as electronic aspirin, needle free diabetes tests, and robotic check-ups. Also, we must increase federal financial aid for tuition to encourage students to go to medical school without graduating with enormous amounts of debt. Some states have introduced programs that provide medical students with aid to pay off medical school costs if they agree to practice in underserved parts of the country for several years upon completion of residency. Another proposed recommendation is to increase the number of residencies for new doctors to work in. While the medical school admission rate can be increased to allow for more doctors to graduate medical school, there are not enough available residency programs for these graduated medical students to matriculate to. A final recommendation proposes increasing the scope of practices for nurses as the shortage of physicians is predicted to expands the responsibilities of nurses. The Nurse Practitioners Modernization Act, which was signed into law with New York's state budget in April 2014, allows nurse practitioners to diagnose and perform medical procedures.

    These proposed solutions are well thought out and simple enough that they can (and should) be implemented sooner rather than later as population growth, insurance expansion, and longer life spans increase the amount of primary care utilization more and more each year.