In the world of health policy, it’s axiomatic that we have a desperate shortage of primary care providers—physicians, physician assistants (PAs), and nurse practitioners (NPs)—in our state and across the nation. Our own surveys of licensed professionals for the Michigan Department of Community Health (MDCH) reveal that only 35 percent of actively practicing physicians are in primary care. It has long been the hope that PAs and NPs would help fill in the primary care gaps where doctors didn’t practice, but our analysis shows that PAs and NPs are no more likely to go into primary care than doctors. (Thirty-four percent of PAs and 39 percent of NPs practice in primary care.) Most health policy researchers think that we need many, many more primary care providers, especially with the rise in patient demand for these services when the Affordable Care Act kicks in full force in less than 11 months.
Two recent reports, however, reflect a powerful tide pushing hard against the shores of conventional wisdom. In the January 2013 issue of Health Affairs, researchers from Columbia and Penn describe a model of primary care that eliminates the so-called shortage of primary care providers. Better yet, it’s a way of delivering care to patients that is more and more common. The keys? Patients have a single primary care physician, but the doctor is in a practice with other doctors, PAs, and NPs who can see the patient when the patient needs to be seen. An electronic health record ties everything together. In the end, this team approach gives patients better access to care and better quality of care. This is the patient-centered medical home, and it’s working for patients and health professionals.
And there appears to be capacity for Michigan primary care doctors to create medical homes. In a January 2013 policy brief, the University of Michigan’s Center for Healthcare Research & Transformation (CHRT) surveyed 714 primary care physicians in Michigan. CHRT found that these doctors “overwhelmingly anticipate having capacity to serve more patients with all forms of health coverage, including Medicaid.” This is consistent with findings from PSC’s annual survey of physicians, which found that 35 percent of more than 1,100 primary care doctors surveyed have practices that are far from full.
Of course, questions remain: How rapidly will most primary care practices change to create teams that can manage more patients better? How can payment policies truly encourage this kind of care? These are real challenges—and they often conspire to stall meaningful progress in health care. But the optimist in me sees opportunity right now. The ACA and its promise of both increased demand and innovative payment may very well lay the groundwork for changes in the way we care for patients, in a health environment they can call home.
By Peter Pratt