Could new care delivery models solve the primary care physician shortage?

New models of primary care delivery could help alleviate the expected shortage of primary care physicians (PCPs) in the coming years, a new study concludes.

The study, published in the November issue of Health Affairs, focuses on the impact of two emerging models of care delivery, the Patient-Centered Medical Home (PCMH) and the nurse-managed health center, both of which rely more on nonphysician providers (NPPs) such as nurse practitioners and physician assistants than most primary care practices do now.

These and other innovative models “have the potential to drastically change the number of providers…needed to provide a given number of primary care services to a population,” the study says, especially when combined with new technology and greater patient self-management. The study was led by David Auerbach, a policy researcher at the RAND Corporation.

Auerbach and his colleagues begin by forecasting the demand in 2025 for PCPs and NPPs assuming that the ratio of PCPs to a given population remains about the same. Then they develop demand forecasts using varying degrees of increased prevalence of PCMHs and nurse-managed centers. The status quo would see a shortage of 45,000 PCPs and a surplus of 38,000 NPPs. If PCMHs and nurse centers were to provide 45% and .5%, respectively, of the nation’s primary care, the shortage of PCPs would be 35,000, and the surplus of NPPs would be 25,000.

If PCMHs and nurse centers provided care to 45% and 5% of the population respectively, the authors forecast that the shortage of PCPs would decrease to 24,000, and the surplus of NPPs would be 11,000. Moreover, a 20% increase in the panel size of the average PCMH provider could reduce the PCP shortage to as little as 7,000.

The authors caution, however, that realizing their forecasts will require additional changes, such as liberalizing scope-of-practice laws to allow midlevel providers to perform expanding roles, and new forms of payment that reward providers for population health management and large panel sizes rather than face-to-face visits.