Shift in physician workforce towards specialists fuels primary care shortage, potential spending growth

Areas with more primary care physicians have lower spending per beneficiary, better care, patient satisfaction and lower death rates, authors say.

The composition of the healthcare workforce is shifting towards specialty physicians while primary care growth has gone flat, and according to a Health Affairs blog post, this trend could mean healthcare spending goes up not down.

Labor represents more than half of health care costs, and clinical workforce is a major driver of use and pricing, authors wrote, and there is plenty of support establishing a link between primary care-centered health systems and lower spending. Specifically, areas with more primary care physicians have lower spending per beneficiary, better care and patient satisfaction and lower death rates.

“Given this, many existing payment reform strategies prioritize primary care, and the success of these reforms will require a vibrant–and likely growing–primary care workforce,” the authors wrote.

Health Affairs delved into the Bureau of Labor Statistics’ Occupational Employment Statistics files between 2005 and 2015, focusing their analysis on limited our analysis to ambulatory health care services, hospitals, and nursing and residential care facilities. There was an overall net increase of 2.6 million jobs over this period, six percent of them being physicians. While the number of primary care jobs rose by roughly eight percent, the number of specialist jobs increased six times faster. Also, the overall share of the physician workforce constituted by primary care fell from 44 to 37 percent, the blog said.

These trends raise concerns for access to care and spending. While in theory, the presence of more specialists in a given market could give way to more competition, lower prices and spending and better outcomes, public payer fees are set administratively and not necessarily susceptible to competition. Hospital/physician integration, patient preference could also hinder competition.

The trend of more specialists working in health systems that charge facility fees on top of already expensive prices for care, and the notoriously large salaries specialists make will also likely drive spending upward, authors said.

In light of the aforementioned belief that the strong presence of primary care providers reduces healthcare spending, the workforce trends may be cause for concern. Moreover, they add urgency to previous recommendations from various agencies aimed at bolstering primary care, like MedPac‘s suggestion that the Medicare fee schedule be altered to reflect the value of primary care and close disparities in the fee schedule that overcompensate certain specialists. HRSAhas recommended in the past the medical school funding be funneled toward students who will work in family medicine and other categories.

“If we are to bend the cost curve, we likely need to move more aggressively on fee schedule changes, payment reform, and workforce policies,” the authors said.

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