Big Picture: 

Prior to the pandemic, a physician shortage was likely, with the greatest shortage being in primary care. Now, after the pandemic, it’s a certainty. Population aging, or an increase in the average age, helps explain the shortage. “Clinician burnout,” worsened by the pandemic, also contributes to the issue. Physicians work shorter hours and retire earlier. What can we do to tackle this problem?

Operative Definitions: 

1. Physician Shortage: A situation where the supply for physicians falls short of the demand.
   
2. Clinician Burnout: Occurs when healthcare professionals are faced with more than they can handle and, in turn, are overworked.
   
3. Physician Assistant (PA): Healthcare professionals who are licensed to work with a physician to practice medicine and provide patient guidance.  
   
4. Nurse Practitioner (NP): Nurses with advanced education and training who provide an entire range of health care services to patients.
   
5. Family Physician (FP): Physicians who provide comprehensive health care services to families and individuals of all ages.
   
6. Registered Nurse (RN): Nurses who have completed a nursing education program and are licensed by the state to provide health services and education to patients.

Important Facts and Statistics: 

1. According to a 2021 study by the Association of American Medical Colleges (AAMC), by the year 2034, a shortage of 17,800 to 48,000 physicians is expected in primary care.
   
2. The aforementioned study by the AAMC reveals that the shortage is expected to be from 37,800 to 124,000 among all types of physicians.
   
3. According to The Washington Post (2019), 41.5% internal medicine (primary care) spots were filled out of 8,116 available.
   
4. The Washington Post (2019) points out that the mean earnings for internal medicine physicians is $243,000 per year, whereas orthopedic doctors’ mean earnings is $482,000 per year.
   
5. The Washington Post (2019) reveals that decreased medical expenses are a factor for patients who meet with a primary care doctor on a normal basis. 
   
6. According to the Pew Research Center, only 3.2% of people residing in the U.S. fell under the category of “unauthorized immigrants” in the year 2017.
   
7. According to a 2021 piece in the Journal of the American Academy of PAs (JAAPA), individual PAs see nearly the same number of patients as family physicians (FPs) in a year, and NPs see nearly 90% as many patients as FPs as of 2019. 
   
8. According to U.S. News & World Report (2018), nursing professor Peter Buerhaus states that NPs achieve results akin to physicians and are more cost-efficient.

Three-Point Plan

(1) Implement robust salary incentives for new primary care physicians. Since primary care is not as lucrative as other specialties in the field of healthcare, an increased starting salary can attract prospective medical school graduates to, ideally, pursue primary care following graduation from medical school. As such, a government-funded boost in salary, specific to recently-employed primary care doctors, should be implemented to encourage this pursuit. Drawing from former Pew Research analyst, Anny Budiman, patients are likely taxpayers. As such, it is fitting that this be funded by the government (i.e., taxpayer dollars) because patients will save money by meeting with primary care doctors on a normal basis.

(2) Offer a tuition reimbursement program to promote the pursuit of nurse practitioner degrees. The state governments in the U.S. can incentivize registered nurse employers by offering to pay for the remaining 50% of tuition if they commit to paying for their share. In turn, a 100% tuition reimbursement will likely encourage current registered nurses to pursue an advanced degree in order to ultimately become nurse practitioners. Consequently, aspiring nurse practitioners can benefit from a free education and the subsequent professional advancement. Employers can benefit by possibly reducing primary care physician shortages as well as overall medical expenses by increasing the nurse practitioner workforce in their facilities.

(3) Provide job-related benefits, including insurance and retirement benefits. Since employer-sponsored health insurance is important in the U.S., providing robust insurance benefits for primary care providers may, at the very least, attract those who are deciding between a primary care role and a more specialized role in healthcare. Offering robust retirement benefits can be a reasonable way to make primary care an attractive choice. This is only to be enforced by states which face shortages of doctors in primary care.

Why This Initiative Is Important: 

Primary care physician shortage is a serious problem that needs to be solved. This shortage directly affects the physical and mental wellbeing of both patients and healthcare professionals alike. For patients in need of health services, a physician shortage could mean longer wait times to see a physician, shorter physician-patient interaction times, and traveling longer distances to receive care. For physicians and other healthcare professionals, a shortage often results in having to work longer hours due to an increased workload. These outcomes are not sustainable. In the long run, many patients are sent to see many different specialists, emergency facilities become overpopulated, and many patients become discouraged altogether from receiving and seeking care. The consequences of physician shortage are wide-ranging. To prevent these severe consequences, changes must be made. An obvious route is to increase the number of primary care physicians in the workforce; however, physician assistants and nurse practitioners can also help to close the gap, with practitioners able to do so cost-effectively. 

Acknowledgements:

The following student worked on this proposal: Jagraj Atwal, University of Pennsylvania, The Wharton School.

Sources:

Budiman, Abby. “Key Findings about U.S. Immigrants.” Pew Research Center, Pew Research Center, 20 Aug. 2020, https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/.

ChenMed. “Preventing The Looming Primary Care Physician Shortage.” ChenMed, ChenMed LLC, 17 Feb. 2021, https://www.chenmed.com/blog/preventing-looming-primary-care-physician-shortage. 

Howley, Elaine K. “Can Nurse Practitioners Help Ease the Growing Physician Shortage?” U.S. News & World Report, U.S. News & World Report L.P., 15 Nov. 2018, https://health.usnews.com/health-care/patient-advice/articles/2018-11-15/can-nurse-practitioners-help-ease-the-growing-physician-shortage.

Knight, Victoria. “America to Face a Shortage of Primary Care Physicians within a Decade or So.” The Washington Post, The Washington Post, 15 July 2019, https://www.washingtonpost.com/health/america-to-face-a-shortage-of-primary-care-physicians-within-a-decade-or-so/2019/07/12/0cf144d0-a27d-11e9-bd56-eac6bb02d01d_story.html.

Staff, NurseJournal. “The 10 Best Places to Work as a Registered Nurse.” NurseJournal, NurseJournal.org, a Red Ventures Company, 11 May 2022, https://nursejournal.org/articles/best-places-to-work-with-a-rn-degree/.

White, Ryan, et al. “Primary Care Workforce Paradox.” Journal of the American Academy of Physician Assistants, vol. 34, no. 10, Oct. 2021, pp. 39–42., https://doi.org/10.1097/01.jaa.0000791476.25727.d9.