According to the Health Resources and Services Administration in May 2013, there was a shortfall of primary care physicians totaling 16,000. And that was before the Affordable Care Act was expected to add 30 million additional insured people to the healthcare system in 2014. Many of the newly insured have delayed seeking medical care for years. When the ACA is fully implemented, there will be a surge in new patients who are not in good health. By 2025, the physician shortfall is expected to top 50,000.
The shortage of primary care physicians is largely a matter of economics. Attending medical school these days can leave a student at least $250,000 in debt. While the starting salary of a primary care physician is around $160,000, radiologists, gastroenterologists, and dermatologists, can make two to three times that amount. In addition, primary care physicians, who spend far more time talking to patients, don’t get as much compensation for patients. They don’t get paid for talking but for procedures, from blood tests to surgery. Most are overburdened with paperwork and negotiating with insurers. To make ends meet, primary care physicians can only spend 6 to 8 minutes with each patient. These factors mean fewer primary care physicians join the workforce every year.
The problem can be address in several ways. Medicare support for physician training has been frozen since 1997. Because all physicians must complete three or more years of residency training, experts say Medicare needs to support at least a 15 percent increase in residency positions. There also has to be a move towards training more nurse practitioners, midwives, and physician assistants who can be brought on line much faster than physicians who require nearly a decade of training.
Since 2010, the Health Resources and Services Administration has been providing scholarships and loans to those who agree to practice as primary care physicians in underserved areas. However, due to budget constraints, this program is only able to fund about half of those who apply. While this program has added more than 10,000 clinicians to the nation’s roles, the statistics remain troubling. The number of primary care physicians is expected to increase 7 percent over the next decade while the number of Americans over the age of 65 will increase 36 percent.