Primary care shortage in the setting of expanding access

I was recently asked to comment for the Hope Street Group on what impact primary care would experience from expanding insurance access. There was an NY Times article about the Massachusetts reform effort.

In Massachusetts, Universal Coverage Strains Care - New York Times

Here was the initial outline I jotted:

• Our nation faces an unprecedented primary care shortage with or without reform

• Increasing health coverage for the uninsured could rapidly increase the future primary care supply gap from ~12k PCP-equivalent FTEs to ~29-68k PCP-equivalent FTEs by 2015 (equivalent to a 10-25% increase in today’s supply), and will add particular strains to the primary care system
• Even in the absence of reform, a shortage of ~12k FTEs (equivalent to a 5% increase in current supply) is projected by 2015
• To serve the 56 M projected uninsured in 2015, 17-56k additional FTEs would be needed, with additional strains on the system due to the unique demands of the uninsured
• Primary care shortages are driven by mismatches in supply and demand that are not immediately addressable through market forces
• Demand drivers include
• Total population growth
• Aging population
• Growing prevalence of chronic conditions
• Supply decreasing due to
• Difficult to ramp up supply: Requires 7 yrs of postgrad training before entering health system
• Compensation gap: Specialists paid 2-3 times more than PCPs
• Difficult to control lifestyle: desire for more “controllable lifestyle” with -2% YoY decline in family medicine residency entrants
• The case study of Massachusetts health reform provides key lessons to keep in mind – in particular, the critical need to address the initial demand surge as the newly insured enter the system, the risk of a “downward spiral” as PCPs become overstretched, and the need for transitional assistance to underserved areas
• The uninsured demand on primary care has specific implications – it will exacerbate the issue of underserved areas, and it will require a geographic redistribution of resources and an immediate surge in PC supply as the newly insured enter the system