Physician shortage could affect 7 million due to ACA insurance coverage expansion

With the Affordable Care Act's (ACA) expansion of insurance coverage expected to increase the need for primary care services – requiring an estimated additional 7,200 primary care providers – seven million Americans could likely face a primary care physician shortage after 2014.

According to a Health Affairs study released as a Web First last week, the expected increase in demand for primary care physicians, along with the ACA's insurance coverage expansion, would directly impact around 44 million people who live in areas of the country where the projected increase in demand for primary care providers is greater than 5 percent of the current baseline supply. Of those 44 million people, seven million live in areas where the demand will exceed the supply of primary care providers by more than 10 percent.
Study author Elbert S. Huang, associate professor of medicine at the Pritzker School of Medicine at the University of Chicago, said the study's findings highlight the need to promote policies that encourage more primary care providers and community health centers to practice in areas with the greatest expected need for services, along with finding new ways to communicate with patients through methods of technology.

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To arrive at their conclusions, Huang and the report's other author, Kenneth Finegold, social science analyst in the Division of Health Care Financing Policy for the U.S. Department of Health and Human Services (HHS), studied the variation in primary care service areas as originally defined by the Dartmouth Atlas group. The authors estimated the number of uninsured in each primary service area in 2010, the number of people expected to gain insurance as a result of the ACA, and the number of providers that would be needed to serve the newly insured.

"I think the most important finding in the study is that there are pockets of the country where there will be a large shortage in the number of providers needed in order to care for the amount of insured people after 2014," said Huang. "These pockets of people in small areas are located in almost every state in the country. Each part of the country will not feel the shortage of primary care at the same time."

Huang added that the increased need for primary care providers will be greater than average in areas of a states with higher numbers of currently uninsured people or fewer primary care providers.

"Massachusetts and their health reform efforts gives us some guidance on what may happen with the possible physician shortages. Their efforts have been successful in expanding coverage, but after that, the people who finally had insurance and needed healthcare showed up at their local emergency department because they had difficulties getting appointments to see clinicians with such long wait lists," he said. "So this could happen in the small areas of the country that have shortages. Basically, patients may show up where we don't necessarily want to see them, like the ED."

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Physician and primary care programs that help staff areas of the country that are already dealing with primary care shortages, like the loan repayment plans and scholarships offered through the HHS Health Resources and Services Administration, are essential for encouraging increased primary care services in underserved areas, said Huang.

"These types of programs basically need to be increased and strengthened," he said.

Huang said local governments should focus on bringing in new clinics and providers to their areas as soon as possible. "It takes a long time to set up clinics and grow networks of providers. We're sort of chasing a problem that's been developing for decades."

Huang added that finding new ways to communicate with patients through technology and using the electronic portal will help the development of local clinics and patient-centered medical homes. "Hopefully doctors and patients can begin interacting more, but with fewer in-office visits."

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