Category Archives: Specialist physicians
A report completed this month by the Congressional Research Service (CRS), which conducts analysis for members and committees of Congress, examines how the Affordable Care Act (ACA) will affect the nation’s supply of physicians. In particular, the report focuses on the workforce’s size, composition and geographic distribution.
The health care system cannot work effectively or efficiently without a physician workforce of appropriate size. Too few physicians means delayed care, and too many physicians can mean unnecessary or duplicate care. But measuring the size of the physician workforce—and the future physician population—is challenging, and estimates vary. The CRS report notes that “predicting the timing, content, and effect of policy change is difficult, which adds to the uncertainty of the projections.”
The ACA authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. It requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents. It also includes provisions designed to increase physician productivity and the volume of physician services available. The law encourages care coordination—in medical homes and accountable care organizations, for example—and expands the non-physician workforce that can augment or substitute for physician services.
Last week, NPR aired a story examining the prognosis for primary care providers in the United States. The country will have tens of thousands fewer health care providers than it needs to care for its the population by 2015, and the shortage is expected to hit rural and underserved areas especially hard.
Part of the problem, the story reports, is that medical students—often saddled with massive student loan debt—are choosing specialties over primary care and family medicine. In addition to higher salaries, specialties allow more schedule flexibility and predictability, and less stress. The nursing workforce, too, has a looming shortage. Many nurses are close to retirement, and a shortage of nurse faculty is making it difficult for nursing schools to educate the next generation.
Provisions of the Affordable Care Act may help alleviate the shortage in the areas most hard-hit, by providing loan forgiveness or other incentives for providers who practice primary care in underserved areas. “A lot of the money in the Affordable Care Act went to beef up programs that train primary care providers, not just doctors but nurse practitioners, physician assistants, what we call mid-level providers,” Julie Rovner, NPR health policy correspondent, said. Primary care “doesn’t necessarily have to be provided by someone with an MD after their name… [There are] lots of studies that say good primary care can be delivered by people like nurse practitioners, by physician assistants, by nurses.”
The show also took calls from listeners—a neurologist, a recent nursing school graduate, a surgical subspecialist, and a nurse practitioner, among them.
Listen to the NPR story or read the transcript here.
A newly released study from the U.S. Government Accountability Office (GAO) finds that children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) have a much harder time obtaining care from medical specialists than do children who are privately insured.
The GAO based its conclusions on its 2010 survey of physicians. Its key findings:
- “More than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs.”
- “A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent).”
In nearly three-quarters of the nation’s emergency rooms, patients might not be getting the urgent care they need because of inadequate on-call coverage by surgical specialists.
RWJF Clinical Scholar Mitesh Rao, M.D, M.H.S. and his colleagues found this alarming shortage in a national survey of emergency department directors. Their findings were published in the December 2010 print edition of Academic Emergency Medicine.
“We hypothesized that overall we would find a good amount of on-call coverage shortages, but we didn’t think the numbers would be that high,” Rao said. “It really stunned us.”
The survey also found that the loss of coverage has a negative effect on hospital ratings. Twenty-three percent of the hospitals experienced a loss or downgrade in trauma center designation levels as a result of on-call specialist coverage problems.
Read the story on the RWJF Human Capital website.