About the Author(s)
Recent Developments
The Affordable Care Act and the Primary Care Physician Shortage
Luis G. Bautista, MD


Abstract: Over the next 10 years, the US will encounter a significant increase in newly insured patients, which will amplify the demand for primary care services. However, over the last several decades, primary care has been an unpopular specialty, resulting in a shortage of primary care physicians (PCPs). The healthcare reform bill, the Affordable Care Act (ACA), contains several sections designed to boost the primary care provider supply.

Keywords: healthcare reform, primary care physicians, physician shortage, health policy

Published: 16 August 2012
Cite as: Bautista LG. The Affordable Care Act and the Primary Care Physician Shortage.
Bull Health L Policy. 2012;1(1): e10.

Introduction

In 2010, Congress passed healthcare reform, also known as the Affordable Care Act (ACA). In part, it was presented to the public as a means to extend medical coverage to our uninsured population.
1 By 2014, the ACA will expand Medicaid to about half of the currently uninsured non-elderly adults.2 In addition, the oldest of the baby boomer generation has reached age sixty-five in 2011, becoming Medicare eligible. Therefore, the near future portends a health-insured population boom, which will increase the need for PCPs.
Unfortunately, over the last several decades, primary care has been an unpopular specialty for physicians.
3 Most physicians specialize in fields outside the realm of primary care.4 The disparity between supply and demand for primary care services will be greatly exacerbated due to rising insured population. In order to support the newly insured, the ACA has included several sections dedicated to promote the primary care workforce. These sections provide financial incentives to PCPs and training institutions, as a means to promote the specialty.

Issue: ACA and Expanding the PCP Workforce
Rise of the Insured
The ACA will result in 32 million newly insured Americans.5 Medicaid eligibility will be reset to incomes 133 percent at or below the federal poverty level, resulting in most single and childless adults qualifying for Medicaid.6 Non-Medicaid covered adults will be required to have health insurance, or pay a fine.

In addition, the elderly population (age 65 or older) will escalate as the baby boomer generation reaches maturity. In year 2000, the elderly numbered 34.8 million, or 12.7 percent of the total population.
7 By year 2020, one in six Americans will be elderly, or 16.5 percent of the population.8 This represents 20 million more elderly Americans than in year 2000.9

Because an insured patient is less likely to neglect their health care needs, while uninsured patients more often decline to receive care,
10 the demand for health care (especially primary care) will grow as more Americans become insured. This large expansion creates tremendous pressure on the primary care infrastructure in the US.

The Primary Care Shortage

Primary care physicians are in high demand, especially in rural and inner city communities.11 Currently about 32 percent of the physician workforce practices primary care.12 As a comparison, in the 1960’s, about half of the physician workforce specialized in primary care.13 Additionally, about 25 percent of primary care providers are near retirement (age 56 or older).14 Hence, there is a primary care deficit looming on the horizon.

Yet, the percentage of U.S. medical students choosing this specialty continues to decline.
15 In 2000, 14 percent of medical students entered family medicine; this percentage declined to just 8 percent by 2005.16 If these trends continue, the supply of primary care providers will erode while a quarter of the current workforce enters retirement age.17

Optimal health care outcomes and efficiency exist when the primary care workforce is between 40-50 percent of the total physician workforce.
18 Accordingly, to reach this goal, an additional 63,000 PCPs are needed to reach the 40 percent level. These figures represent what is required for the current insured population, and therefore the gap will expand with a rise with the number of insured and PCP attrition.19

ACA and Primary Care

Title V of the ACA specifically deals with the primary care workforce.20 Certain key sections attempt to increase PCP reimbursements, training, and recruitment. Beginning in 2011, no coinsurance or deductibles are charged by traditional Medicare plans for many preventive medicine services.21 This will eliminate patient cost sharing and encourage them to receive more preventive care, which will increase billable patient visits for PCPs.22 Medicare will also cover annual comprehensive wellness visits.23 Medicare and Medicaid will increase reimbursements by 10 percent to physicians who devote 60 percent or more of their practice to primary care.24 Additionally, the ACA will match Medicaid reimbursement rates to Medicare for PCPs during 2013-2014.25 These sections are aimed at providing an immediate increase in reimbursements for PCPs who treat the Medicare and Medicaid patients.

The ACA also contains many sections that attempt to promote primary care training. Current PCPs, training institutions, medical schools, federal scholarships, National Health Service Corps, and nurse-managed health clinics will all receive increased funding to help boost the primary care workforce.
26 The ACA also establishes a National Health Care Workforce Commission, which will serve as a national resource for Congress, the President, and state governments, regarding supply and demand of the medical workforce.27

Conclusion
Healthcare reform under the ACA may help increase our primary care workforce and provide accessible services to the growing number of insured in the US.

Competing Interests:
None reported
Acknowledgments: None reported

Author(s)
Luis G. Bautista, MD, is a second year student at California Western School of Law and Treasurer of the Health Law Society. Dr. Bautista received his undergraduate degree in Biology from the University of San Diego, and his MD degree from New York Medical College.

References (Bluebook)
1. Good News for People With Medicare, http://www.healthcare.gov/ (last visited Nov. 22, 2011).
2.
See The Uninsured: A Primer, The Henry J. Kaiser Fam. Found., 1, 22 (Oct. 13, 2011), available at http://www.kff.org/uninsured/upload/7451-07.pdf (last visited Nov. 20, 2011).
3.
See 2009 State Physician Workforce Data Book, Ass’N of Am. Med. Colls., 1, 5, available at https://www.aamc.org/download/47340/data/statedata2009.pdf (last visited Nov. 22, 2011).
4.
Id.
5. See Advancing Primary Care, Council on Graduate Med. Educ., 1,3, available http://www.hrsa.gov/advisorycommittees/bhpradvisory/cogme/Reports/twentiethreport.pdf (last visited Nov. 20, 2011).
6.
The Uninsured: A Primer, supra note 2, at 8.
7.
Long-Term Care, Aging Baby Boom Generation Will Increase Demand and Burden on Federal and State Budgets: Hearing Before the Spec. Comm. On Aging, 107th Cong. 10 (2002) (Statement of David M. Walker, Comptroller General of the United States), available at http://www.gao.gov/new.items/d06365r.pdf (last visited Nov. 20, 2011).
8.
Id.
9. Id.
10. The Uninsured: A Primer, supra note 2, at 12.
11.
Advancing Primary Care, supra note 5, at 14.
12.
Id. at 15.
13.
Id.
14.
Id. at 4.
15.
Id. at 5.
16.
Id. at 13.
17.
Id. at 9.
18.
Id. at 15.
19.
Id. at 3.
20. The Patient Protection and Affordable Care Act, 42 U.S.C. §§ 5001-5701 (2010).
21.
See Medicare at a Glance, The Henry J. Kaiser Fam. Found., (2010), available at http://www.kff.org/medicare/upload/ 1066-13.pdf (last visited Nov. 22, 2011).
22.
Focus On Health Reform: Summary Of New Health Reform Law, The Henry J. Kaiser Foundation, (2011), available at http://www.kff.org/healthreform/upload/8061.pdf at 10 (last visited Nov. 22, 2011).
23. Id. at 11.
24. The Patient Protection and Affordable Care Act, 42 U.S.C. § 5501 (2010).
25.
The Uninsured: A Primer, supra note 2, at 21.
26. The Patient Protection and Affordable Care Act, 42 U.S.C. §§ 5001-5701 (2010).
27. The Patient Protection and Affordable Care Act, 42 U.S.C. § 5101 (2010).


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