Physician pooling, care diversion: Answers to PCP shortage?

Under a traditional primary care model, physician shortages could increase to be even worse than expected over the next 20 years. A new study, however, reveals that greater use of non-physicians in primary care and increased adoption of healthcare technology could eliminate any shortage completely.

The traditional model of primary care-in which patients are cared for by a single doctor-won’t fulfill the needs of a post-healthcare reform nation in which more Americans have access to regular medical care, according to a new report from researchers at the Columbia Business School and the Wharton School at the University of Pennsylvania. Continued use of the traditional model would ignore patient access considerations and would result in “unacceptably long” appointment backlogs, the authors note. Offering advanced access-allowing up to 75% of patients to make same-day appointments-under the single-physician model will require about 25% more full-time-equivalent (FTE) physicians than currently needed under the traditional model.

In contrast, an advanced access system that would allow patients to see other doctors if their designated primary care physician (PCP) was unavailable and would divert 20% of cases to non-physicians, the number of required FTE PCPs would drop by almost 32%, thereby completely eliminating the threat of a PCP shortage, the study authors contend.

PCP shortage predictions rely on the formula that one FTE physician is required for every 2,500 people. The Affordable Care Act and an aging population, however, are expected to increase the number of people seeking regular medical care and exacerbate any shortages.

Open scheduling, or advanced access, is a newer principle used to in relation to Patient-Centered Medical Homes. Advanced access systems use reduced patient panel sizes to accommodate same-day appointment requests and offer more flexibility to patient scheduling.

The traditional model of care could result in PCP shortages that are worse than already predicted. The traditional type of practice is disappearing, however, researchers note; PCPs increasingly are joining group practices and being employed by hospital systems. Primary care practices also are moving toward greater use of non-physicians in practice, with nurse practitioners accounting for 19% of the primary care workforce and physician assistants accounting for another 7%.

Physician pooling and diversion demand offer relief from the strains of physician shortages, the study reveals, and could eliminate the shortages predicted under traditional PCP practice models.

Chief concerns about pooled physician practices and diversion of care is that it could have a negative effect on continuity of care. But study authors argue that continuity of care will be facilitated by the increasing adoption of electronic health record systems that allow doctors to update patient data that can then be accessed by other physicians. Under the traditional model of primary care practice, patients who cannot access their PCPs often turn to emergency departments of clinics that don’t have access to their medical records or notes from the PCP, so newer models may actually increase continuity of care rather than disrupt it, researchers note.

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