The availability of primary care is a key component in sweeping reforms designed to make health care accessible to all Americans.
The rub is there aren’t enough primary care providers to go around.
All of Kent and Sussex Counties and parts of New Castle County have shortages of primary care physicians, according to federal guidelines. The ratio is less than one doctor for every 3,500 patients, says a report by the Delaware Health Care Commission.
Physicians are getting grayer, too. Half of PCPs practicing in the state are over 50; 16.3 percent are over 65.
“That means that we need to find a lot more providers,” says Dr. Tom Stephens, medical director of Westside Family Healthcare.
Westside, a federally qualified health center, has PCPs on staff, doctors who focus on family medicine, pediatrics, obstetrics and gynecology and internal medicine, as well as various levels of nurses.
“We have always had a good balance of doctors, nurses and advanced practice nurses,” Stephens says. “That is the model for a patient-centered medical home.”
About 80 percent of tasks traditionally handled by doctors can be managed by a nurse practitioner or physician’s assistant, says Dan Hawkins, senior vice president of public policy and research for the National Association of Community Health Centers in Washington, D.C.
“Don’t ask a physician to see a kid with an earache,” he says. “Ask him to see the patient with serious pulmonary problems or diabetes, the serious stuff.”
But Delaware also is expected to have a shortage of nurses in the next decade, says a report by the Mid-Atlantic Community Health Association. That is of particular concern to FQHCs because nurses who speak Spanish are especially scarce; only one percent of nurses in the state are Hispanic, according to the Delaware Health Care Commission.
Nearly half of health center patients at Delaware health centers—48 percent—are Hispanic. Nearly one in four—22.3 percent—forego checkups because they speak little or no English, according to the Governor’s Consortium on Hispanic Affairs.
The Affordable Care Act will funnel $80 million into training for advanced nursing. The government also is increasing Medicaid payments to PCPs and is expanding its program to forgive student loans for PCPs who practice in underserved areas.
Still, there will be a shortage of 63,000 doctors by 2015, according to the Association of American Medical Colleges. AAMC expects that number to more than double to 130,600 by 2025.
The pipeline for delivering new providers is long—four years of medical school, plus a three-year residency. Programs for physicians’ assistants and advanced practice nurses typically take three years.
“It takes time, a lot of time,” Hawkins says.
In the short term, providers will look for ways to be more efficient.
For example, cutting down on paperwork can optimize doctors’ work time. Advances in technology supported under the ACA will help to free physicians from office work so they can concentrate on caring for patients.
“It sounds simple, but when billing, coding and other non-care centric work is removed, PCPs gain more time for more patients,” says Ryan Wise, vice president at athenahealth, a Massachusetts-based provider of web-based business services for medical groups, including FQHCs. “The PCP shortage can be helped tremendously if operational and non-clinical work is delegated outside of the care environment.”