Late Breaking News
Shortage of Primary Care Providers Expected to Intensify
- Categorized in: March 2009 Issue
WASHINGTON—It has been two years and the Yakima Neighborhood Health Services in Yakima, Wash, is still trying to recruit an internist for a vacant slot. For a federally qualiﬁed health center that treated about 16,000 users last year, staff vacancies are problematic.
“The idea that we have spent two years trying to ﬁll one spot—this never would have happened two years ago, it was unheard of,” said Anita Monoian, CEO/President of the Yakima Neighborhood Health Services, who has been with the center for nearly 30 years.
Another concern for the center has been ﬁnding enough pediatricians, according to Rhonda Hauff, chief operating ofﬁcer at Yakima Neighborhood Health Services.
“Typically, we have ﬁve full-time pediatricians on staff and we have had one vacancy over a year now that we have been trying to ﬁll. We are losing another pediatrician this spring who has been with us for over 13 years, primarily because in the community as a whole we have a shortage of physicians and it puts a larger burden on those who are remaining,” Hauff said.
Physician shortages such as those at the Yakima Neighborhood Health Services are not an unusual phenomenon in the U.S. and studies predict that such shortages will continue to be an issue.
A 2008 Association of American Medical Colleges (AAMC) study called The Complexities of Physician Supply and Demand: Projections Through 2025, projected a physician shortage of 124,000 physicians by 2025. In that study, projected shortages in primary care accounted for more than a third of the total projected shortages.
The report noted, “though the supply of physicians is projected to increase modestly between now and 2025, the demand for physicians is projected to increase even more sharply.”
The fact that the demand for healthcare workers is outpacing the supply, particularly in primary care, is a concern to the Health Resources and Services Administration, the primary federal agency charged with improving access to healthcare services for people who are uninsured, isolated or medically vulnerable.
“By and large folks suggest that there may be a physician workforce shortage by about 100,000 physicians by 2025,” said Marcia Brand, Ph.D., associate administrator for Health Professions at HRSA. “Similarly, as we forecast out into the future, [we may be short] as many as a million nurses. In general, where we are coming up with these projections is based on the demographics, the increasing number of older individuals who have multiple chronic conditions. The baby boomers are retiring and it is a smaller generation behind them to ﬁll their positions.”
Dr. Brand said that there are many questions about how the current recession will impact the healthcare workforce shortage. “I think that what we could never have anticipated was either the challenges or opportunities that the economic downturn will mean to the healthcare workforce,” Dr. Brand said. “We are still scratching our heads in trying to get a good understanding of what the economic downturn means generally to the workforce.”
One challenge in bolstering the healthcare workforce is the high debt that many medical graduates face. One potential outcome of the economic situation could be that some medical students who thought they might want to be primary care physicians at the beginning of the 2008 academic year may have changed their minds this year.
“Primary care is where we have some the greatest shortages and primary care physicians are probably the folks who are reimbursed the least upon graduation. We hear anecdotally that folks don’t go into primary care because they have high rates of student indebtedness, easily up to $200,000 by the time they add up their undergrad and their medical school education,” Dr. Brand said. “So, I’m concerned that at the beginning of the second semester a student who thought they may be family physicians and/or primary care doc is going to say, ‘Now I have taken out all of these loans and scholarships and I can’t really afford to be a primary care doc. I’ll never be able to pay this down.’”
On the other hand, the economic downturn could spur some individuals looking for a stable career to go back to school and choose a healthcare career, such as nursing. “If you can afford to go to school and study in a ﬁeld where you think the jobs are going to be a bit more stable you might go back to nursing school,” she said.
Dr. Brand said the agency has recently rolled out a health workforce information center at www.healthwork forceinfo.org. The website is intended to be a “one-stop shop” for health professionals, employers, government agencies, researchers, policymakers and anyone who needs up-to-date information on health workforce topics and trends.
The website provides free access to resources on the nation’s healthcare workforce and information on events and funding opportunities. The center can be contacted to provide customized information. The project is funded by HRSA and operated by the University of North Dakota School of Medicine and Health Sciences.
Stimulus Bill Increases Funding
Health organizations are hopeful that funding included in the stimulus package for HRSA training programs will help spur growth in the primary care healthcare workforce.
The new law includes $300 million for HRSA’s National Health Service Corps, a program that recruits and places health professionals at eligible sites within underserved areas. NHSC recruits primary care physicians, nurse practitioners, dentists, mental and behavioral health professionals, physician assistants, certiﬁed nurse-midwives and dental hygienists. These providers serve in community-based systems of care in return for scholarship or loan repayment assistance.
“It is the quintessentially perfect program,” according to Dan Hawkins, senior vice-president for Policy and Programs at the National Association of Community Health Centers, Inc., an organization that represents health centers from around the country. “We are really pleased for a program whose current funding is only about $120 million, to get in the stimulus $300 million over two years. We certainly will be back on Capitol Hill talking to members of Congress about the need to sustain that higher rate of growth. It creates the opportunity for signiﬁcantly addressing the shortages of providers, not just at health centers, all of which are in underserved communities, but in many other underserved communities and institutions of care, be they health departments, community clinics or other places.”
In addition to the $300 million for the National Health Service Corps, the bill also includes $200 million for Title VII and Title VIII programs in HRSA’s portfolio. Titles VII and VIII authorize initiatives for training programs for students in order to improve the geographic distribution, quality and racial and ethnic diversity of the healthcare workforce with an emphasis on primary care. Title VII programs support physician, dentist and allied health profession training, while Title VIII programs fund nursing education and nursing workforce diversity.
Tannaz Rasouli, senior legislative analyst at the AAMC said that these programs have been underfunded in the past and so the funding is a step in the right direction.
“The funding that is included in the recovery package for the health professions training is deﬁnitely a welcome ﬁrst step to reversing the chronic underfunding of these successful programs over the last few years. These are very important programs,” Rasouli said. “We would like to see that funding sustained and increased because it’s the long-term picture that we are really concerned with and training takes time. So for a country that is talking about healthcare reform and addressing healthcare coverage, we need to make sure that we have the providers in place to actually provide that care,” she said.
Still, funding for training programs is only one piece of the puzzle in increasing providers, particularly those in primary care, according to Hawkins.
“Part of it is public support for those programs. What we are up against is a marketplace where customers, for a lack of a better term, want more dermatologists, we want more gastroenterologists; we want more surgeons who can do liposuction. Those who enter those professions earn a heck of a lot more and [for] a medical student who is in their third or fourth year of medical school those career paths seem a lot more attractive. So changing this process to produce more primary care clinicians, it has so many facets to it that changing it is going to be a long, slow slog.”