By Sterling Medical Staff
The high availability of Family Practice positions is an indication of the looming shortage in the US. The American Academy of Family Physicians (AAFP) estimates the 139,531 family practice physicians will be needed by 2020 (7). The AAFP’s projection was based on the number of Family Practice Physicians in the workforce and the total number of completed residencies in “allopathic and osteopathic schools” (1).
This number represents roughly 42 family practice physicians per 100,000 people in the United States (7). The AAFP estimates that, in order to reach this ratio, family practice physician residency programs would need to expand by approximately 822 residents per year(7).
The predictions made by the AAFP did, however, have noted difficulties. It was noted that predications based upon historical data may not be foretelling. The main reasoning behind this is unexpected advances in medical technology and factors which might influence physician specialty choice.
The Health Resources and Services Administration (HRSA) noted that any models of future supply and demand, especially in the field of family practice physicians, would incorporate problems that are present in the current health care system.
Sufficient research has concluded that “the nation’s over reliance on specialty care services at the expense of primary care leads to a health care system that is less efficient” (1). On the other hand, it has been concluded that care stability, preventive care, and care coordination, can all accomplish savings and positive health care outcomes.
In contrast, family practice physicians are not able to increase their arsenal of services without sacrificing patient-time, thus decreasing quality. The price of conventional medical services also puts family practice physicians at a disadvantage.
In Boston, Massachusetts, Medicare’s fee for a 25 to 30-minute office visit for an established patient with a complex medical condition is $103.42 (6), in contrast, Medicare’s fee for a diagnostic colonoscopy—a procedural code which accounts for the same period of time—is $449.44 (6).
Numerous findings continue to bring up questions regarding the discretion of a health care system which thinks too little of primary care services. For example,
“Patients of primary care physicians are more likely to receive preventive services, to receive better management of chronic illness than other patients, and to be satisfied with their care” (2).
“States with more primary care physicians per capita have better health outcomes—as measured by total and disease-specific mortality rates and life expectancy—than states with fewer primary care physicians” (3).
“States with a higher generalist-to-population ratio have lower per-beneficiary Medicare expenditures and higher scores on 24 common performance measures than states with fewer generalist physicians and more specialists per capita” (4).
“The hospitalization rates for diagnoses that could be addressed in ambulatory care settings are higher in geographic areas where access to primary care physicians is more limited” (5).
- 25A.B Bindman et al., “Primary Care and Receipt of Preventive Services,” Journal of General Internal Medicine vol. 11, no. 5 (1996); D.G. Safran et al., “Linking Primary Care Performance to Outcomes of Care,” Journal of Family Practice, vol. 47, no. 3 (1998); and A.C. Beal et al., “Closing the Divide: How Medical Homes Promote Equity in Health Care: Results From The Commonwealth Fund 2006 Health Care Quality Survey” (The Commonwealth Fund, June 2007).
- B. Starfield et al., “Contribution of Primary Care to Health Systems and Health,” Milbank Quarterly, vol. 83, no. 3 (2005).
- K. Baicker and A. Chandra, “Medicare Spending, the Physician Workforce, and Beneficiaries’ Quality of Care,” Health Affairs web exclusive (2004).
- M. Parchman et al, “Primary Care Physicians and Avoidable Hospitalizations,” Journal of Family Practice, vol. 39, no. 2 (1994).
- The fee for this service in Boston, Mass., is represented on the fee schedule as CPT code 45378.