TL/DR –
The current system for tracking primary care shortage areas in the U.S. is flawed, as it only counts physicians and does not take into account other healthcare professionals who provide primary care. Policymakers have been attempting to address these shortages, but without accurate data, it’s difficult to measure the success of these efforts. A Health Affairs study found that federal designations, which help allocate an estimated $1 billion in annual funding through at least 20 federal programs aimed at boosting primary care capacity, haven’t significantly changed the situation; over 180 areas have remained on the primary care shortage list for at least 40 years.
Primary Care Shortage in Rural US Areas Impacts Patient Care
Valley-Wide Health Systems, servicing 13 rural Colorado counties, often have their hands full, providing a range of medical services to those in need, including laboring women and those with lacerations. Chief Medical Officer, Emelin Martinez, however, had issues finding a full-time medical provider for their clinic in Costilla County.
Despite incentives like federal student loan repayments, bonus Medicare payments, and faster visas for foreign clinicians, Costilla County, a primary care shortage area, couldn’t find a physician for over a year.
Government policies have endeavored to draw more primary care providers to these areas, with examples including the Biden administrationamplifying funding in 2022 to address shortages. There are frustrations, though, about the effectiveness of these policies due to the flawed data the government collects on primary care shortage areas.
A study by Health Affairs shows that despite $1 billion in annual funding for federal programs to enhance primary care capacity, these initiatives have had limited success in addressing these shortage areas.
Many doctors opt out of primary care careers due to heavy workloads and lower pay than specialists. As such, the nation needs to develop solutions, but identifying strategies is challenging without comprehensive knowledge of these shortage areas and the necessary care providers.
David Bowman, a spokesperson for the Health Resources and Services Administration, which manages the shortage designations, revealed that over 80% of clinicians who receive scholarships or loan repayments continue practicing in shortage areas past their obligation of several years.
However, doctoral student Justin Markowski found that the federal shortage designation doesn’t improve physician density in the long term and remains skeptical about major primary care fixes.
Rethinking Incentives for Physicians
Persistent shortage areas may be a result of incentives being too small or short-lived. Another aspect is how these shortages are measured. These include geographic shortage areas, population groups such as migrant farmworkers, and specific facilities like prisons lack enough providers.
Stephen Petterson, a senior scholar at the Robert Graham Center, pointed out the flaws in the shortage area system, noting that it only counts physicians, not other crucial primary care providers.
Despite these shortcomings, there is hope. Costilla County finally found an experienced physician assistant from Texas who will provide primary care, potentially moving the county out of its critical shortage.
However, this achievement may remain unnoticed on a national scale, as this physician assistant isn’t a physician, and Costilla County will likely remain identified as a federal shortage area.
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