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“We haven’t invested enough in primary care”: Stanford expert talks about California’s doctor shortage

1178px-Doctors_stethoscope_1As I waited for my routine checkup recently, I read a report on the critical shortage of primary care physicians in California – ironic reading material for my primary care physician’s waiting room.

The report, titled “Horizon 2030: Meeting California’s Primary Care Workforce Needs,” was recently released by the California Primary Care Association. It concludes that California will need an estimated 8,243 additional primary care physicians by 2030, or an increase of 32 percent of its current workforce.

The authors identify key barriers that undermine primary care recruitment, such as the growing cost of health training and associated student debt combined with concerns about primary care compensation. It also suggests strategies on how to overcome these barriers.

Curious about the actual state of affairs, I spoke with Laurence Baker, PhD, professor of health research and policy, about the Horizon 2030 report and California's primary care shortage.

Why are primary care physicians so important? What happens if we don't have enough?

We know primary care has a lot to offer. Research shows that primary care physicians often manage patients in ways that are both less expensive and higher quality — particularly for patients with complex chronic conditions where primary care physicians can often be more responsive to the complexities of individual patients.

Having enough primary care physicians is key to getting our health-care system where it needs to be. If we end up without enough, it’ll be harder to achieve our goals of lowering cost and improving quality. Unfortunately, it’s becoming clear that we aren’t sufficiently staffed up for primary care, especially as health-care reforms like the Affordable Care Act result in more people with access to preventative care and basic health coverage.

How can we significantly increase the number of primary care professionals in California?

I think we’ll need multi-dimensional approaches that involve governmental policies, actions by private insurance companies, adaptations in medical education and probably more. Over time a shortage in primary care needs to be partly remedied by new physicians training in primary care. So policy can play a role to do things to help make primary care attractive, like ensuring good pay for primary care physicians, since we’ve often had skewed payment methodologies that favor specialties. Expanding training capacity in medical schools could also help.

But we also need actions that can help sooner than that, so other things will be needed. We should be expanding nurse practitioner or physician assistant programs, exploring whether incentives like targeted primary care loan forgiveness programs can help, and looking at ways to get people already in medicine to expand their primary care work.

How accurate are these types of estimates on a future workforce?

I think estimating the future workforce is a difficult thing to do with a lot of precision. Any time you make these kinds of estimates, you have the difficult job of guessing what medicine will look like tomorrow, and medicine is always evolving. In this case, though, while I think one can always question the exact numbers, the overall situation in which we find ourselves is pretty clear. The bottom line is that we haven’t invested enough in primary care.

Previously: Clickwell Care: An online primary care program designed to meet the needs of young patients and Spotting stellar primary care practices, Stanford study identifies 10 practices that lead to excellence
Photo by Stethoscopes

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