The Impending PCP Shortage: How Bad Is It?
The Impending PCP Shortage: How Bad Is It?
Medscape: Are Accountable Care Organizations (ACOs) going to be part of the solution to the shortage problem?
Dr. Pugno: I think the ACOs are certainly building on a patient-centered medical home model and, in doing so, will take advantage of the team approach. As I said right at the very beginning, I think teams are going to expand our capabilities in providing primary care services to the population. The fact is that the population is growing and aging much faster than ACOs are being created. That will be a challenge. The other is that the capacity within the system right now to take more patients is going to be very difficult. The vast majority of family doctors that I'm aware of have more patients than they can handle. They're not going to be recruiting for a large influx of new patients.
Our practice profile survey says that our members are seeing something on the order of 8-10 patients a week who have no insurance or lack adequate insurance. The fact that that the population now will get insurance is not going to actually make a difference in the volume that family doctors can handle. This is because many, many currently uninsured patients are already getting care, but for free. Thus, insurance coverage for them means their care will no longer be a cost to the system. However, it also means that the huge influx of patients into the system may not be as burdensome on primary care doctors as people predict.
Medscape: Are you seeing any light at the end of the tunnel?
Dr. Pugno: Well, that's why we're leaning on Congress to do something. We don't have enough primary care providers. The patient-centered medical home setting will take best advantage of the team and will mitigate the impact of this influx of people seeking primary care, but it's going to be bad.
Of course, one problem is that Congress is more or less deadlocked on what healthcare reform should look like. The other is, obviously, the global situation. The government is certainly being overwhelmed with conflict around the world. In addition, there are our basic economic problems here at home. We can say to Congress, "Oh, by the way, we want you to pay close attention to an impending problem in healthcare access," but it's really hard to get their attention with all of the other distractions.
Medscape: Do you see any solution?
Dr. Pugno: The solution is for primary care providers to get paid like proceduralists. Then the growth in people gravitating toward careers in primary care would escalate rapidly and would certainly have a positive impact on primary care access.
In the present environment, an increasing number of medical students are graduating with a debt that's the equivalent of a large home mortgage, and they're saying to themselves, "I could be a primary care physician and make $120,000 a year, or I could be a radiologist and make 4 times that and pay off my debts really quickly." Those are real-life decisions. I can't fault our medical students who are carrying a lot of debt looking out for themselves and their families in terms of economic security. Payment reform and reform of graduate medical education training support toward primary care are really going to be the solutions.
Frankly, until somebody acts, be it the legislature or whomever, the challenge is going to escalate. Implementation of the patient-centered medical home and the implementation of the ACOs are going to blunt that impact a little bit, but the fact is that it's coming.
Solutions: ACOs, Teams, and More Money
Medscape: Are Accountable Care Organizations (ACOs) going to be part of the solution to the shortage problem?
Dr. Pugno: I think the ACOs are certainly building on a patient-centered medical home model and, in doing so, will take advantage of the team approach. As I said right at the very beginning, I think teams are going to expand our capabilities in providing primary care services to the population. The fact is that the population is growing and aging much faster than ACOs are being created. That will be a challenge. The other is that the capacity within the system right now to take more patients is going to be very difficult. The vast majority of family doctors that I'm aware of have more patients than they can handle. They're not going to be recruiting for a large influx of new patients.
Our practice profile survey says that our members are seeing something on the order of 8-10 patients a week who have no insurance or lack adequate insurance. The fact that that the population now will get insurance is not going to actually make a difference in the volume that family doctors can handle. This is because many, many currently uninsured patients are already getting care, but for free. Thus, insurance coverage for them means their care will no longer be a cost to the system. However, it also means that the huge influx of patients into the system may not be as burdensome on primary care doctors as people predict.
Medscape: Are you seeing any light at the end of the tunnel?
Dr. Pugno: Well, that's why we're leaning on Congress to do something. We don't have enough primary care providers. The patient-centered medical home setting will take best advantage of the team and will mitigate the impact of this influx of people seeking primary care, but it's going to be bad.
Of course, one problem is that Congress is more or less deadlocked on what healthcare reform should look like. The other is, obviously, the global situation. The government is certainly being overwhelmed with conflict around the world. In addition, there are our basic economic problems here at home. We can say to Congress, "Oh, by the way, we want you to pay close attention to an impending problem in healthcare access," but it's really hard to get their attention with all of the other distractions.
Medscape: Do you see any solution?
Dr. Pugno: The solution is for primary care providers to get paid like proceduralists. Then the growth in people gravitating toward careers in primary care would escalate rapidly and would certainly have a positive impact on primary care access.
In the present environment, an increasing number of medical students are graduating with a debt that's the equivalent of a large home mortgage, and they're saying to themselves, "I could be a primary care physician and make $120,000 a year, or I could be a radiologist and make 4 times that and pay off my debts really quickly." Those are real-life decisions. I can't fault our medical students who are carrying a lot of debt looking out for themselves and their families in terms of economic security. Payment reform and reform of graduate medical education training support toward primary care are really going to be the solutions.
Frankly, until somebody acts, be it the legislature or whomever, the challenge is going to escalate. Implementation of the patient-centered medical home and the implementation of the ACOs are going to blunt that impact a little bit, but the fact is that it's coming.
Source...