Primary care physician drop-off cannot be solved by universal coverage alone

New report examines the decreasing numbers of primary care physicians. Source: Primary Care Physicians Medical Corp.

Though access to primary care protects health and cuts costs, there are not enough primary care doctors and nurses to meet the demand. This situation cannot be solved simply by expanding health insurance coverage, according to a study by National Association of Community Health Centers (NACHC), the Robert Graham Center and George Washington University in Washington, D.C.

The study found that the availability of a primary care work force depends on location, and primary care clinicians are not locating in areas with the most need, especially low-income communities. The study includes state-level projections of growing patient needs expected to stretch the healthcare system in years ahead.

“The primary care workforce situation is one of the biggest policy challenges facing the U.S. healthcare system today, but too often the debate is mostly about expanding health insurance,” said Dan Hawkins, senior vice president for policy and programs of NACHC. “If every American alive today had health insurance, millions still wouldn’t be able to access the primary care that ensures better overall health and reduces healthcare costs. That’s because provider locations and career choices don’t match up to the need. If we want to fix our healthcare system, we need to be having the right conversation.”

Among the study’s findings:

• Health centers face a greater demand for work force than other sources of primary care. Today, they would need to hire more than 1,800 additional primary care providers (doctors, nurse practitioners, physician assistants and certified nurse-midwives) and almost 1,400 additional nurses to reach provider/patient ratios comparable to the primary care field as a whole.
  
  
• To reach 30 million patients by 2015, health centers need up to 19,500 primary care providers and up to 14,400 nurses. Slightly more than one third of the needed work force is non-physician primary healthcare professionals.
  
  
• To provide a medical and healthcare home to all 56 million medically disenfranchised Americans and continue to serve current patients, health centers will need up to 60,000 more primary care professionals, and up to 44,500 additional nurses.
  
  
• Alaska, Wisconsin and Washington, D.C., have the most providers per patient, while Nevada, Alabama and Oklahoma have the fewest.

According to NACHC, one year after Massachusetts began its health insurance mandate, the rate of uninsured adults dropped from 13 to 7 percent, yet the proportion of adults reporting that they could not find a primary care physician and therefore went without care rose 75 percent.