Students of healthcare issues think that the national debate over policy and payment issues is ignoring the fact that a crisis is quietly developing in the reduction of primary care physicians (PCP). The American Association of Medical Colleges estimates that the U.S. will face a shortage of 49-100,000 primary care physicians by 2030. This estimate is similar to others, such as the Department of HHS, which projects a shortage of 20,000 PCPs by 2020.
The crisis is multi-factorial. As people live longer, they consume more primary medical care. At the same time, physicians are retiring at a younger age due to, among other things, an increasing regulatory burden. And more young doctors are opting for non-clinical careers.
Some observers think this problem will be alleviated by the increasing use of “physician extenders,” such as Physician Assistants (PAs) and nurses with advanced degrees of expertise. Nurse-practitioners in some states, including Washington, can work in clinics that do not have a physician available, and can do almost everything a doctor does except performing surgeries.
Most doctors who choose to become primary care clinicians obtain their advanced training in “residency” programs, such as those at medical schools. This additional training, in which the doctors rotate through various “services,” such as dermatology, surgery, or rheumatology, provide the wide experience needed to both provide in-office medical are and also to serve as the “gate-keeper” for referrals to specialists.
A problem has been that, as the number of applicants to the National Residency Matching Program has risen in recent years, the number of residency “slots” has increased more slowly. This resulted in federal legislation called the Resident Physician Shortage Reduction Act of 2015, which provides additional funding for medical schools and other medical facilities to increase the number of PCP residency positions.
Other solutions to the PCP shortage have been to rely more on foreign medical school graduates to have access to PCP jobs. This effort has been hampered by sponsorship and immigration and visa complications, which have become more difficult in the Trump presidency.
