TO: Honorable Carolyn B. Maloney and Honorable Richard N. Gottfried
FROM: Kevin Budway
RE: Primary Care Shortage
DATE: February 15th, 2015
The Affordable Health Care Act is creating the opportunity for many people without
current health insurance coverage to get it. However, this is creating a great strain on the
healthcare industry that is not prepared for the increase in insured citizens. The main area
that is affected is primary care. There are simply just not enough doctors in primary care
to treat the great influx of the newly insured.
The Primary Care doctors are the front line of medicine. They are the first medical staff
to recognize, identify and perhaps begin treatment for many patients. They are also the
medical staff that must have the best assessment skills. They are the area of medicine that
concentrates on preventative medicine as well. They try in layman’s terms to keep the
general population healthy by educating the population on however to stay of get healthy.
Without this key component in the healthcare industry having enough qualified doctors to
take up the ranks the general population will suffer. Take for example a patient with high
blood pressure that goes untreated or a smoker that goes on with their life not knowing of
all the recourses available to them for help quitting. This is also potentially disastrous for
the emergency departments throughout the state because now the patient with the
untreated high blood pressure will end up in the emergency department with a heart
attack or stoke. The smoker that was unaware of all the recourses available to them goes
into the emergency department with chest pain. All of these examples are examples of
exactly what might be harmed if a policy is not put into place that will remedy the
shortage of primary care doctors in our state.
The fact is not that we don’t have enough doctors to fill these ranks, as some might think,
but it is because there are too few doctors that are choosing this area of practice. This is
because they are choosing more lucrative avenues of practice in specialty areas not
related to primary care. Another cause is that there has been little growth in residency
slots, which is the on-the-job training program that doctors have to go through. There
have been “113,000 in 2011-2012, up from 96,000 a decade earlier” (Rampell, 2013)
according to the NY Times.
“After all Congress, through Medicare, subsidizes the vast majority of residency slots, at
$10.1 billion annually, or an average of $112,642 per resident per year. Congress froze
the number of subsidized positions in 1997, and hospitals argue that the best way to train
more doctors is for congress to open the spigot and fund more jobs.” (Rampell, 2013)
While this seems to be a logical argument behind congress simply flooding the industry
with money to help train the doctors there is some data that suggests hospitals are more
profitable under this training system.
Another cause might be the fact that doctors are mounting large tuition debt while in
school therefore forcing them into the more lucrative areas of medicine. This and other
factors therefore force the primary care area of medicine onto the international medical
graduates. “In 2005 and 2006, about one quarter of all visits to office-based physicians in
the United States was to international medical graduates.” (Steinbrook, 2009) “However,
merely increasing the number of medical schools, medical students, or residency
positions that could produce primary care physicians will have limited effects if US
medical students continue to shun such careers” (Steinbrook, 2009)
The fact is that there will have to be a way to collaborate in the role of primary care
providers amongst doctors, nurse practitioners, and physicians’ assistants. The opinions
of doctors and nurse practitioners however currently differ on what the roles of advanced
practice nurses or physician assistants should be in primary care. While much of nursing
education is on preventative care making them, at times, better suited for primary care
medicine there is still a dissenting opinion amongst doctors as to the safety of care an
advanced practice nurse might be able or not able to provide.
And so we see that problem of the shortage of primary care doctors is a complicated one
that is amplified by the Affordable Health Care Act. The possible solutions are to
increase funding and scholarship into the area of primary care for doctors and residency
programs. Another is to collaborate with other medical clinicians such are advanced
practice nurses and physician assistants. Either way this is a problem that must be
addressed within the public policy arena. There have been many states granting nurse
practitioners the sole autonomy to practice primary care and I believe that addressing this
policy matter in our own state is a must.
I would like to thank those addressed above for your time and anticipated cooperation in
helping the state of New York address the issues of a primary care physician shortage.
References
Steinbrook, R. (2009). Easing the shortage in adult primary care — is it all about money?
N Engl J Med, 360(26)
Rampell, C. (2013). Solving the shortage in primary care doctors. New York Times