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Expanding Primary Care in the Short Term

Dec 22, 2011, 8:50 PM

Current efforts to bolster the primary care workforce may not be large enough or work fast enough to meet increasing demand or to thwart an impending shortage of providers, according to a new report from the National Institute for Health Care Reform.

Efforts to increase the number of licensed physicians, advanced practice nurses (APNs) and physician assistants – through training programs, scholarships, loan forgiveness and higher payment – may take decades to bear fruit, according to the report, Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage. The health reform law’s provisions to increase the workforce may not boost the supply of primary care providers in time and they may not be sustainable, the report warns. While possible long-term solutions are in place, other approaches are needed to more quickly increase primary care capacity.

“Given the supply of advanced practice nurses currently delivering primary care and the shorter time frame required for training new entrants, broadening scope-of-practice laws for APNs is a possible avenue to expand primary care capacity more rapidly,” the report says. While each state has jurisdiction over scope-of-practice laws, authors of the new report suggest that federal policy-makers could offer financial incentives to states that allow APNs to practice independently.

Another approach the report suggests is to adopt payment policies that encourage team-based care, which has the potential to deliver care to a greater number of patients than physicians working alone. Methods such as capitated payments or case management models “may incentivize and encourage the development of teams that share care responsibilities,” the authors write. There are concerns, however, about physician satisfaction and whether team-based care truly increases efficiency.

Read the report.

Read the Robert Wood Johnson Foundation brief, Assuring Access to Care Under Health Reform.

What do you think? Are current efforts to bolster the primary care workforce taking too long? What other options should policy-makers consider? Register below to leave a comment.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.