Findings by the Rand Corporation (a nonprofit institution that performs research/analysis with the goal of improving policy) was published in the November issue of Health Affairs. Their study results propose that the expected shortage of physicians could be alleviated through expanding patient-centered healthcare settings (staffed by a team of healthcare professionals) and the roles of physician assistants and nurse practitioners.
Affordable Care Act
The Patient Protection and Affordable Care Act (aka Obamacare)’s mandate is to help 32 million Americans obtain health insurance by the year 2019, thus potentially 32 million new individuals are/will be “entering the health care system,” states the Association of American Medical Colleges.
Forecasts reveal that as more and more Americans become insured and seek healthcare, physician shortage could soar as high as 45,000 doctors by the year 2025.
New Models of Care
“Growing use of new models of care that depend more on nonphysicians as primary care providers could do much to reduce the nation’s looming physician shortage,” said RAND policy analyst and the study’s lead author, David Auerbach, as quoted by RAND’s press release.
By new models of care, RAND is referring to expanding “patient-centered medical homes and nurse-managed health centers” which could help deal with 50% (or more) of the projected physician shortage.
According to RAND, currently medical homes account for approximately 15% and nurse-managed health centers account for around 0.5% of primary care in the U.S. “If medical homes expand to deliver nearly half of primary care, the nation’s expected physician shortage would fall by 25 percent, according to the RAND study,” states Monday’s press release. “If nurse-managed health centers expand to account for 5 percent of primary care, the doctor shortage would fall by another 25 percent.”
Nurse-managed care settings are often associated with academic health centers and run by nurse practitioners and nurses.
Patient-centered medical homes typically function with a team of health professionals. “A physician, physician assistant or nurse practitioner leads the team of doctors, nurses, pharmacists, nutritionists and social workers using electronic health records and care coordination,” described USA Today’s Kelly Kennedy (November 4, 2013). “Each team can care for larger numbers of patients than a doctor could on his or her own.”
The expansion of these care settings is seen to be plausible as medical homes have already been rapidly increasing (there are also Medicaid, Medicare and other pilot programs driving this development); and up to $50 million in grant funds for nurse-managed centers is being facilitated under the Affordable Care Act.
Expanding the roles of nurse practitioners and physician assistants and adopting more patient-centered settings is not without its challenges, however. “State laws may need to be changed to widen the scope-of-practice for both nurse practitioners and physician assistants so they can fill a wider role in primary care,” states RAND. “In addition, there is a need for medical assistants, licensed practical nurses and aides to perform key functions in the new care models…”
Auerbach says they need to do more analysis, but that researchers are optimistic having already observed successful examples.