Can the ACA Fix the Primary Care Shortage?

A linchpin of the Affordable Care Act is more access to primary care physicians—mainly through Medicaid—for those who were heretofore uninsured. This is expected to offer coverage for primary care for an additional 35 million to 39 million people who previously did not have it. Primary care is important as it has been found to lower rates of mortality, deliver better outcomes for patients and cut the cost of care.

One of the issues that needs to be addressed is an adequate supply of clinicians to take care of this surge in demand.

The ACA put in place initiatives to meet this new demand: an increase in care extenders (e.g., nurse practitioners, physician assistants); improved access to technology (such as medical records and remote monitoring); improved payment for clinicians; new care models such as medical homes (meant to integrate all care givers around a patient’s needs); and incentives to increase the number of physicians going into primary care (such as bonus payments).

Primary care providers can include physicians in family medicine, general internal medicine, OB-GYN, geriatrics and psychiatry, and nonphysicians such as nurse practitioners and physician assistants.

Whether the primary care supply is adequate to meet the increase in demand is an ongoing debate among policymakers. Some feel the demand cannot be met based on a significant number of the initiatives being tested and implemented at the same time. In other words, there are too many moving parts for the ACA’s initiatives to work. Others feel that by providing integrated primary care models with heath care information technology, the primary care provider supply will be adequate.

What are the ramifications of not having an adequate supply of primary providers to meet this new demand? People new to the system may seek care at sites that are very expensive— the emergency room for example— or may not seek care at all. If a chronic condition such as diabetes needs attention, care may need to be delivered in a setting that is more expensive than a physician office setting, especially if a complication results from the condition.

It will be interesting to see how this plays out over time.