Shortage of Primary Care Providers (by Kayla Sahlfeld)

kayla.sahlfeld-Community HealthcareIntroduction

Healthcare is a topic that I hold near and dear. As far back as I can remember, I have been fascinated with the human body, and the healthcare industry. While the United States has fantastic healthcare compared to most of the rest of the world today, it is still flawed. After a few years of working in the field, I have noticed a recurring theme, and after just a small amount of reasearh I noticed that I was not the only one whose attention had been brought to this. Across the board, it can be extremely difficult to establish a primary care doctor/general practitioner, especially if you have state funded health care coverage. This shortage of primary care doctors also plays into some other problems that healthcare is facing today, such as extraordinarily long wait time in emergency departments. I strongly feel that if this main problem is addressed, it will have a positive ripple effect on the rest of the healthcare system.

Shortage of Primary Care Providers

In recent years, the US has made leaps and bounds in getting people covered with health insurance. With this surge of newly covered individuals, doctor’s offices have been busier than ever. While this is all wonderful, it can be very difficult to establish care with a primary doctor to provide the preventative healthcare that everyone deserves. Either the doctor is already overwhelmed with the number of patients they treat, the clinic may limit the number of new patients a provider may take on, or the provider may not be contracted with that patients insurance. With more people being covered with insurance and seeking preventative care, these problems are becoming very prevalent in our community. With a staggering number of medical school graduates pursuing a specialty rather than general medicine, it is no wonder that establishing primary care with in our community can be so hard to accomplish. Healthcare is huge, diverse, and complicated industry and addressing problems within is easier said than done. However, as a society, if we push for the correct changes we will see results.

Admissions to medical school can be a long, grueling, stressful process. Decisions are made based on how a student presents on paper, far before they are able to present themselves in person, which should be just as important as a gleaming academic record. Selections are based on many factors including grades, extracurricular activities, volunteer hours and work experience. However, very little consideration is given to who a person is, and what they plan on doing with their lives. Even though “personality and background may be fuzzy gauges for selecting students, schools are giving these factors more weight in the hope of admitting students genuinely interested in primary care. So volunteering at a homeless shelter, say, counts more than being president of a fraternity. And applicants with rural home addresses are apt to catch the attention of admission committees because they’re thought more likely to return to rural areas as primary physicians.” (Slomski, 1993). If admissions representatives were able to better screen individuals personalities and interest, there may be more luck in produces more general practitioners to care for our growing community.

So, what happens after medical school anyway? If all the years of medical school isn’t enough already, those aspiring to practice medicine in the United States must then be matched a residency program in the specialty they prefer. However, not everyone gets matched to the program of their choice. In fact as many as 10% of seniors (Are, 2017) don’t get matched with a program at all and can’t apply again until the next year. What happens in the mean time? This problem “has never been adequately addressed in health care reforms, including in the Affordable Care Act (commonly known as Obamacare). It can, however, be significantly ameliorated by making some relatively modest policy changes to the current framework for physician training and licensure that would take advantage of the pool of available medical graduates to help alleviate the current and predicted physician shortage” (Dayaratna, 2017). Laws should be created so that in the time spent waiting for the residency of their choice, medical school graduates could work under a licensed primary care physician, just as a Physician’s Assistant would. This would allow clinics to see accommodate more patients, as well as helping graduates beef up their application for a residency (and hey, they may find out that they like being in primary care!)

One highly underutilized resource in primary care, are providers who are not doctors. Certified nurse practitioners and physician’s assistants can often provide high quality care just as a doctor would. The training to become either a PA or NP is not as rigorous as medical school, takes less time and therefore less expense on the student’s behalf. With more specialists than primary or “generalists”, we will be forced to “look to non-physicians to provide generalist care. No other industrialized country does that, but maybe the United States has to be different.” (Holoweiko, 1992). This could be an outstanding opportunity for the United States to take the lead in providing more widely accessible preventative and primary care to its citizens.

Many leading organizations in healthcare in our community such as Providence, Kaiser, and Peacehealth set strict limits on the number of active patients any provider may have. While this can be good, preventing greedy doctors from taking on more patients than they can adequately care for, it can also be a hindrance to those efficient doctors who could take on more of a patient load. It should be the doctor’s decision about how many patients they are comfortable with, and how many they can provide quality care for. It should not be in the hands of the organization that employs the doctor to determine how many patients to take on. This is another place in which Physician’s Assistants could play a key role in widespread healthcare where they would be seeing patients alongside the doctors in a clinical setting. More providers mean more accessible healthcare, and that is a win for everyone.

Needless to say there are many flaws with the healthcare system in the United States. This however, does not mean that it is a ‘bad’ system, in fact it is still one of the best in the world but there are flaws with anything. Fixing the system will take much work, and the changes will happen slowly. Healthcare in the United States is a trillion dollar industry, and covering the cost is a justified worry, but it is worth it. Mahatma Gandhi once said “It is health that is real wealth, and not pieces of gold and silver.” As members of this community and citizens of this great country it is important to evaluate what we can do to help one another.

Bibliography

The difficulty of establishing a primary care doctor/general practitioner is something that people in our communities face every day. Seeing as I currently work in health care, I see it quite frequently that people are often forced to be seen in emergency departments for things that could be easily taken care of elsewhere. One of the biggest problems with establishing a primary care is that there just isn’t enough doctors for all the people, not enough generalists anyway. I want to explore why this is, and what we can do about it.

Are, Chandrakanth, Hugh Stoddard, Lauren A. Carpenter, Brigid O’Holleran, and John S. Thompson. “Trends in the Match Rate and Composition of Candidates Matching into Categorical General Surgery Residency Positions in the United States.” American Journal of Surgery, Jan. 2017. Web. 30 May 2017. Holoweiko, Mark. “Must America Look to Non-doctors for Primary Care?” Interview by Steven A. Schroeder. Medical Economics 21 Dec. 1992: 82. Print.

Dayaratna, Ph.D. Kevin D. “Addressing the Physician Shortage by Taking Advantage of an Untapped Medical Resource.” The Heritage Foundation. N.p., n.d. Web. 04 June 2017.

Slomski, Anita J. “Will Med Schools Solve the primary-care shortage?” Medical Economics. 70.14 (July 26, 1993): p87

 

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One comment

  1. Selah Johnson

    Kayla,
    Your personal introduction really caught my attention and impressed on me the importance of your paper to you. I came this paper with some background and agreement on the subject already so I was hoping you had some extra depth or research I could add to my repertoire to convince others around me. I know some primary care physicians that need to be booked at least 6 months in advance for annual exams and most of the ‘urgent’ care issues get handled by their nurse practitioner. I felt that some of this shortage was the lack of prestige and relatively low pay for primary care physicians vs specialists. I like the idea of medical school graduates working as physician assistants though I don’t understand why this couldn’t be counted as their residency? I found it interesting you brought up certified nurses and physician’s assistants. I had read an article previously directed at people interested in the medical field encouraging them to take that route as an alternative to attending medical school for basically the same reason, that PAs and CNPs are doing much of the work that had previously been done by primary care doctors without that monetary and time burden of medical school. Indeed with the ease of access to specialists one could argue that the range of knowledge needed by primary care practitioners is less these days than in the past.

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