Could Alternate Primary Health Care Centers Mitigate the Anticipated Physician Shortage?

A new study from the INQRI-coordinated Future of Nursing National Research Agenda, featured in the November issue of Health Affairs, finds that increasing the number of nurse-managed health centers and patient-centered medical homes could mitigate the projected physician shortage. These institutions rely less on physicians as primary care providers, and more on nurse practitioners (NPs) and physician assistants (PAs).

The research team, led by David Auerbach, MS, PhD, a policy researcher at the RAND Corporation, calculated how many physicians would be required to provide primary care in 2025 under various scenarios involving increased demand for those services, and that included expanding the number of patient-centered medical homes and nurse-managed health centers. The was co-funded by the Donaghue Foundation.

The researchers noted that while studies project an increase in the numbers of clinically active full-time-equivalent primary care physicians, NPs, and PAs, stronger growth is expected for the latter two providers. For instance, while there were four primary care physicians for every primary care NP in 2010, projections suggest that there will be just over two physicians per primary care NP in 2025. Assuming no growth in medical homes or health centers, the research team projected a shortage of 45,000 primary care physicians in 2025 (putting supply 20 percent below demand), a surplus of 34,000 NPs (48 percent higher than demand), and a surplus of 4,000 PAs (10 percent higher than demand).

They found that medical homes and health centers tend to provide primary care services to the same population as traditional models, but with fewer physicians. Therefore, increasing the prevalence of medical homes from providing 15 percent of the nation’s primary care in 2010 to providing 45 percent in 2025 would reduce the primary care physician shortage by a quarter to 35,000. Increasing the prevalence of nurse-managed health centers from providing .5 percent of the nation’s primary care in 2010 to 5 percent in 2025 had roughly the same effect. Greater prevalence of both health care delivery models (about half of all primary care delivered in health centers and medical homes), would cut the physician shortage nearly in half. If medical homes are able to leverage their comprehensive approach to treat more patients, the shortage could be eliminated.

The authors also note that increasing the number of nurse-managed health centers and patient-centered medical homes may require changing some state laws to allow NPs and PAs to play expanded roles in primary care. They point out that this will increase the need for medical assistants, licensed practical nurses and other providers who perform key functions in integrated care models. It may also require changing payment structures to reward providers for managing population health rather than a fee-for-service model. More information about the study is available here and an abstract of the study is available here.