Changing medical education requirements needed to alleviate primary care shortage

Researchers also advocate for more NP and PA authority

Researchers at the John Chambers College of Business and Economics at West Virginia University examined the primary care shortage stemming from the pandemic and came up with six possible solutions.

1) Changing medical education
2) Expanding physician assistant and nurse practitioner independence
3) Federal regulation of telemedicine
4) Expanding the interstate medical licensing compact
5) Special telemedicine licensing
6) National licensure.

“COVID-19 has been very costly, but if there is one silver lining, it has prompted some rethinking of the many health care regulations,” said Ed Timmons, an economist and one of the study’s authors, in a statement. “If it made sense to eliminate the regulation during the pandemic, it is worth considering if the regulation will be necessary moving forward.”

Timmons and his co-author, Conor Norris, say occupational licensing reduces the supply of professionals in a regulated field and restricts geographic mobility, factors leading to the health care shortage

“Occupational licensing laws make it a crime to work in a profession without meeting minimum levels of education and training, paying fees to the state and passing exams,” said Timmons. “Although they set minimum levels of entry, they also discourage entry and disproportionately impact the disadvantaged. Research documents that occupational licensing raises prices and increases unemployment.”

When it comes to changing medical education, the authors say the pathway to a medical degree in the United States takes longer and is costlier than in other countries. To become a medical doctor in the U.S. requires a bachelor’s degree before completing four years in medical school, in addition to a years in residency. Medical students in countries such as Australia, Ireland, and South Korea, have the choice of earning a six-year consolidated medical degree.

“It would be great if interested students could complete a three-year credential for medical school,” Timmons said. “Of course, all of this would hinge upon medical schools changing their admissions criteria and accepting the new three-year credential. Medical schools, however, must comply with accreditation standards.”

Timmons noted that the typical medical school graduate in the U.S. can accumulate more than $200,000 in debt, a deterrent for physicians becoming general practitioners.

The researchers also advocate for physician assistants and nurse practitioners to be able to practice independently of physician oversight. Regulatory requirements in about half of states prevent them from practicing to their full training and ability.

Access to primary care in rural and underserved areas would improve with greater practice independence, Timmons said.

“Redesigning medical education and allowing PAs and NPs to practice independently consistent with their training will alleviate their shortage,” Timmons and Norris concluded. “Other reforms that encourage telemedicine or make migration between states easier will help underserved populations receive care.”