Care Transformation

Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients' ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We used simulation methods to provide estimates of the number of primary care physicians needed, based on a comprehensive analysis considering access, demographics, and changing practice patterns. We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care-including the use of teams or "pods," better information technology and sharing of data, and the use of nonphysicians-have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage.

[1]  T. Bodenheimer.  Lessons from the trenches--a high-functioning primary care clinic. , 2011, The New England journal of medicine.

[2]  E. O'neil,et al.  Primary care health workforce in the United States. , 2011, The Synthesis project. Research synthesis report.

[3]  Ira Moscovice,et al.  Expansion of coverage under the Patient Protection and Affordable Care Act and primary care utilization. , 2011, The Milbank quarterly.

[4]  P. Cunningham.  State variation in primary care physician supply: implications for health reform Medicaid expansions. , 2011, Research brief.

[5]  B. Potts,et al.  Sustaining primary care practice: a model to calculate disease burden and adjust panel size. , 2011, The Permanente journal.

[6]  James Stahl,et al.  Improving Clinical Access and Continuity through Physician Panel Redesign , 2010, Journal of General Internal Medicine.

[7]  M. Naylor,et al.  The role of nurse practitioners in reinventing primary care. , 2010, Health affairs.

[8]  Terhilda Garrido,et al.  The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. , 2009, Health affairs.

[9]  L. Green,et al.  Reducing Delays for Medical Appointments: A Queueing Approach , 2008, Oper. Res..

[10]  T. Rosenthal.  The Medical Home: Growing Evidence to Support a New Approach to Primary Care , 2008, The Journal of the American Board of Family Medicine.

[11]  R. Kruse,et al.  Will generalist physician supply meet demands of an increasing and aging population? , 2008, Health affairs.

[12]  R. Cooper.  New directions for nurse practitioners and physician assistants in the era of physician shortages. , 2007, Academic medicine : journal of the Association of American Medical Colleges.

[13]  Joy M Grossman,et al.  Physicians moving to mid-sized, single-specialty practices. , 2007, Tracking report.

[14]  L. Green,et al.  Providing timely access to care: what is the right patient panel size? , 2007, Joint Commission journal on quality and patient safety.

[15]  M. Mitka.  Looming shortage of physicians raises concerns about access to care. , 2007, JAMA.

[16]  Lynda C Burton,et al.  Using electronic health records to help coordinate care. , 2004, The Milbank quarterly.

[17]  P. Parkerton,et al.  Primary care practice coordination versus physician continuity. , 2004, Family medicine.

[18]  D. Berwick,et al.  Advanced access: reducing waiting and delays in primary care. , 2003, JAMA.

[19]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[20]  R. Hooker,et al.  Use of physician assistants and nurse practitioners in primary care, 1995-1999. , 2001, Hospital quarterly.

[21]  R. Hooker,et al.  Use of physician assistants and nurse practitioners in primary care, 1995-1999. , 2001, Health affairs.

[22]  M. Murray,et al.  Same-day appointments: exploding the access paradigm. , 2000, Family practice management.

[23]  R L Kane,et al.  Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. , 2000, JAMA.

[24]  P. Kletke,et al.  Current trends in physicians' practice arrangements. From owners to employees. , 1996, JAMA.