By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: The Affordable Care Act and the PCP Manpower Shortage
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > The Affordable Care Act and the PCP Manpower Shortage
Health ReformPublic Health

The Affordable Care Act and the PCP Manpower Shortage

GlennLaffel
GlennLaffel
Share
6 Min Read
SHARE

The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act created Medicare in 1965. It assures that 32 million Americans will gain access to health insurance for the first time. But who will care for these people?

The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act created Medicare in 1965. It assures that 32 million Americans will gain access to health insurance for the first time. But who will care for these people?

The flood of newly insured people will create a surge in demand for physician services. By 2015—one year after the major provisions of the ACA take effect—the US will have 63,000 fewer physicians than it needs to meet this demand, according to the Association of American Medical Colleges.

The shortfall will hurt everyone, but its impact will be devastating for medically underserved populations where finding a doctor is already difficult. This includes nearly 20% of the US population.

More Read

White House’s Obamacare Support Tweet Attracts Haters
Seeing Patients by the Dozen: Group Appointments Are Increasing
mHealth Fitness Trackers Have a Long Way to Go
Statistics on Medicare Re-Hospitalizations and Readmissions Penalties
Everything We Are Doing in Health Policy May Be Completely Wrong

Unfortunately, the ACA doesn’t include a manpower plan that sufficiently accommodates the surge. The most optimistic projections suggest it will add 500 or so physicians per year to the workforce during the next decade, and even that modest growth has recently come under attack by House Republicans.

Two weeks ago, the GOP-controlled House voted 234 to 185 to eliminate $230 million in mandatory ACA funding for the creation of a new teaching model for residents in primary care. The model is based around “teaching health centers,” which would be placed in medically underserved areas and mirror the practice environment residents will enter upon completion of their training.

The GOP isn’t against the new training model, but objects to the automatic, mandatory payouts associated with it. They propose that funding for the manpower initiative should be subjected to votes each year during Congress’ annual appropriations process. “It’s time to move these programs back to the discretion of this Congress,” Marsha Blackburn (R-Tenn.) explained, referring to it as one of many  “slush funds” provided by a debt-ridden federal government. 

Democrats counter that subjecting the funds to an annual, politically-charged appropriations process will dissuade physicians from entering primary care. “Training physicians should be assured with funding they can rely on,” said Rep. Henry Waxman (D-Calif.).

The House bill will likely never see the light of day in the Democratically controlled Senate. But it is distressing that Congress is wrangling over a largely inadequate solution to the coming physician manpower crisis.

What Should Be Done?
The AAMC has asked Congress to require at least a 15% increase in residency training slots beginning immediately. This would add 4,000 physicians per year to the pipeline. To do this, the AAMC suggests that Congress overturn a 1997 law that froze Medicare-funded residency positions, and increase by at least 15% the number of GME positions funded by Medicare.

This isn’t a bad idea, but it seems like a pipe dream with public opinion entrenched against new spending programs and Congress posturing for the press around various budget deficit plans.

The only viable alternative was proposed by the Institute of Medicine last fall. The IOM concluded  that the best way to deal with the coming tidal wave is to expand the roles and responsibilities of nurses.

Reasoning that nurses are cheaper and quicker to produce than doctors, the IOM recommended incentive programs that increase the number of nurses with bachelor degrees to 80% by 2019. It further recommended that nurses assume central roles in redesigned, team-based care systems, and that regulatory and institutional obstacles, including limits on nurses’ scope of practice, be removed so that advanced practice registered nurses can practice more freely. This includes increasing their power to prescribe drugs.

To IOM report cited studies of care systems (including the VA) that have already implemented such models. The studies show the new systems to have experienced no fall-off in the quality of care while cutting the annual increase in health expenditures by more than 50%.

Although organized medicine has scoffed at the IOM report, I think these changes are inevitable.  The ACA is right-minded, socially responsible legislation that can improve access to care for tens of millions of Americans, but it can’t work (especially in an era of unprecedented deficit spending) unless health professionals figure out how to transform our health system so as to better leverage its professional workforce.

A redesigned system that focuses on patients is a lofty, socially responsible goal, the kind that drives people to become health professionals in the first place. Physicians will sit atop these newly redesigned teams and remain responsible for patient care; they needn’t worry about that. But they need to set-aside any unreasonable urges they may have to keep the status quo and let this transformation occur. Otherwise, they are going down with the ship.

TAGGED:healthcare reformpublic health
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

a woman walking on the hallway
6 Easy Healthcare Ways to Sit Less and Move More Every Day
Health
September 9, 2025
Clinical Expertise
Healthcare at a Crossroads: Why Leadership Matters More Than Ever
Global Healthcare
September 9, 2025
travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025

You Might also Like

Big Tobacco is Still Targeting Our Kids

March 23, 2012
Nurses Who Fight the Flu Shot
Public Health

Nurses who fight the flu shot

January 6, 2016

Vermont Moves Closer to Single Payer Delivery

March 25, 2011
blood cholesterol
CardiologyNewsPolicy & LawPublic HealthWellness

New Blood Cholesterol Guidelines

November 14, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?