The United States Healthcare System

Less access to primary health care services (Close The Gap n.d; Couzos & Denaley 2007)

There is an imbalance between primary and specialty care services in the U.S. health care delivery system.

(as cited by Yee, Boukus, Cross, & Samuel, 2013). Poghosyan, Lucero, Rauch, and Berkowitz (2012) reported that the U.S. will be deficient by more than forty-five thousand primary healthcare physicians by the year 2020 and that the affordable care act (ACA) health care reform will increase the demand once thirty million residents acquire coverage.

According to the federal Health Resources and Services Administration, or HRSA, at least 55 million Americans live in areas with an inadequate supply of primary care doctors. Massachusetts has the most primary care doctors per capita; Mississippi has the fewest.

Economics and health were two independent subjects in high school, but nothing is truly independent in the real world. Supply and demand, one of the principals of economics, perfectly sums up the problem with primary health care. The supply of primary care physicians, also known as PCPs, is lacking by almost 52,000 providers to be able to fulfill the demand of the public within the next couple of years, and this isn’t a new issue (Petterson et al., 2012). Since the 1970’s there has been a shortage of PCPs, and it is becoming a bigger problem as the population grows and ages (Wilensky, 2014). The number of PCPs currently in the United States is not enough to meet the needs of the population. The view of primary care physicians and their salaries need to change in the U.S. to encourage more medical students to enter this much-needed field of practice. This paper will explore the reasons behind the shortage of PCPs and how the Affordable Care Act and the American Nurses Association are addressing this issue.

The physician shortage is of highest concern in the United States, especially since the Patient Protection and Affordable Care Act has been passed. The question is, do we really have a physician shortage? Is it by geographical region or by specialty? I will explore this question and have several different solutions to the physician shortage problem.

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

Americans will have insurance coverage. The US has an unequal distribution of the primary care, thus; the rural areas have been left with only few physicians. Many physicians prefer practicing in urban areas because of the lucrative advantage, better technology or demographic preference. Many sources including Green et al, of Anita Phigpen Perry School of nursing confirms that the reason for the shortage of physicians in the rural areas is due to the tendency of people in the rural areas being poorer, sicker and older . This segment of people tends to be uninsured, and physicians are attracted to urban and suburb areas where revenues are. Today with the ACA policies, people in the underserved area have better access to physicians, although the shortage persists. The US Department of Health and Human Services, states that to help strengthen access to the primary care workforce, the Affordable Care Act invests in health work force training, including: a $ 1.5 billion investment in National Health Service Corps Scholarship and loan repayment programs and $ 230 million over five years to primarily train medical residents in community-bases. However, do we have enough experts?

In addition to the challenges of the primary care physician shortage, the shortage will also have a great impact on health care organizations from a business perspective. The shortage will have a great effect because physicians are revenue makers for healthcare organizations. The care primary care physicians provide translates into billable services that make up the organization’s income. It is reported that the average physician generates approximately $1.4 million in income for a healthcare organization (Amirault, 2014). Therefore, organizations operating with less primary care physicians could experience significant revenue loss. For example, if a health care organization is short a single primary care physician it could mean longer appointment waiting times for patients. This could result in patients choosing a different organization for their medical care and the health care organization will lose money. The organization will be affected in other ways as well because fewer primary care physicians mean lower patient satisfaction and quality of care. From a business perspective, the shortage of primary care physicians will

The projected physician shortage is well documented. Several estimates have been made as to the severity of the shortage with the Association of American Medical Colleges (AAMC) predicts required 46,000 physicians to meet demand and a study by Cowell et al putting the number at 44,000 by 2025 (1). The reasons for this increased demand are numerous. For starters, as John Prescott, AAMC chief academic officer, says, “There 's 10,000 more baby boomers every single day in the U.S. and those individuals tend to require additional care” (2). Those baby boomers requiring care will undoubtedly include retiring physicians; 2,504 family physicians are expected to retire in 2015 alone with that number only expected to grow in upcoming years (1). In addition to the increased care inherently required by elderly patients the Affordable Care Act (ACA) has expanded medical insurance to several that have never had access before; while this is great news to those with coverage for the first time it also increases the number searching for a physician. A report prepared for Congress stated that the ACA was poised to increase the shortage of physicians by 8,000 by 2025 (4). Even current clinics have been forced to turn down 250 potential patients a day due to a lack of physicians causing sick persons to drive hours to find care (3). Compounding the problem, new physicians tend to shy away from the 60-hour weeks worked by their predecessors instead looking for a better work/life balance (2, 3).

A healthy primary care base is critical to the running of an effective health care system. People who have access to PCP’s are more likely to receive preventive and timely care for medical conditions. Having a PCP is also associated with fewer emergency department visits and fewer hospital admissions (Abrams, Nuzum, Mika, & Lawlor, 2011). Developed countries have made primary care the foundation of their healthcare system. The U.S. followed this model until 1949, and since that time PCP’s have been steadily declining (Shi & Singh, 2015). A study by West and Dupras in 2012 showed that only 21.5 percent of third year internal medicine residents intended to continue on and make general internal medicine their career (Shi & Singh, 2015). Today, most medical school graduates are entering specialties such as anesthesia, cardiology and

On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into

The first characteristic of the US health care system is that there is no central governing agency which allows for little integration and coordination. While the government has a great influence on the health care system, the system is mostly controlled through private hands. The system is financed publically and privately creating a variety of payments and delivery unlike centrally controlled healthcare systems in other developed countries. The US system is more complex and less manageable than centrally controlled health care systems, which makes it more expensive. The second characteristic of the US health care system is that it is technology driven and focuses on acute care. With more usage of high technology,

Primary care, or day to day care, is expected to rise significantly over the next five years because of the increase in population as well as the aging of an already staggering population. Also having some to do with the increase in health care is the expansion in health insurance. If the fundamentals of primary care remain as they are, there is expected to be a shortage of 20,400 primary care physicians by the year 2020. If non-physician practitioners are integrated into the system, such as in patient-centered medical homes, the stress that will be on the health care system will be somewhat alleviated. In a study done by the US department of health and human services, national averages in areas where primary care physicians is well above average their numbers will remain above average, while areas where the number of primary care physicians is well below average will be severely struggling. Aging population and population growth accounts for 81 percent of the change, while the remainder is taken into account because of the implementation of the Affordable Care Act. To help with the increase in health care services needed, primary care nurse practitioners is expected to increase roughly 30 percent, and if primary care nurse practitioners would be integrated into the primary care health setting it could help alleviate up to 6,400 jobs by 2020. The institute of medicine reported that primary care physician shortages are based on the traditional health care delivery model,

A forecast by the National Conference of State Legislatures, predicted that by 2015, there would be a shortage of primary care physicians in the sum of 21,000. Moreover, the passing of the Affordable Care Act 2010, would add an additional 32 million Americans to the toll (NCSL.Org, n.d.). However, research supports evidence that individuals who attain regular primary care obtain more defensive services against disease, cooperate with their preset medical care, and have less occurrences of illness and early demise. Without a doubt, this is attributed to a collaborative team approach to care. Furthermore, this type of care provides direction to the patient as they pilot the very multifaceted health care organization. Lastly, care of this