At first glance, the future of primary care may seem unpredictable. For the most part, however, it will probably be an acceleration of changes already underway prior to the pandemic. Whatever the future has in store, it will be shaped by an anticipated shortfall in the primary care workforce. In addition, an aging population with chronic conditions and multiple ailments will add to the impact this will have on America’s health care system.
The American Association of Medical Colleges projects that by 2033 there will be a shortfall of as many as 55,200 physicians going into primary care. Older physicians are retiring and fewer medical students are replacing them. Burdened by high debt loads upon graduation, younger doctors are more likely to choose higher paying specialties. This means that nurse practitioners and physician assistants will be playing an ever-increasing role in providing primary care.
Today, there are more than 290,000 licensed nurse practitioners in the United States, with about 70% involved in delivering primary care. There are also about 131,000 physician assistants; more than 20% of them are involved in primary care. Most NPs and PAs are currently working in group practice settings alongside physicians, who oftentimes act as supervisors and coordinators of patient care. There’s little doubt that team-based care, including expanded use of NPs and PAs, will become an increasingly popular business model.
Providing continuity of care has always been considered an important element in the doctor-patient relationship. Spending the time needed as determined by the individual patient’s needs, both physical and mental, has never been more important than now. Faced with a changing practice landscape, doctors are looking for ways to address this concern while still preserving their autonomy.
One approach gaining in popularity is concierge medicine, a practice in which the patient pays the doctor a retainer for being available 24/7 for unlimited office visits, telephone, email, hospital visits … maybe even house calls. The doctor can spend more time with the patient because the size of the practice is limited to perhaps 500 patients, instead of the usual 2000. The typical cost to the patient is a fixed fee of $1,500 to $2,000 per year.
Another approach is to simply stop accepting insurance. This allows the doctor to spend more time with patients instead of haggling with insurance companies. The patient is expected to pay a reasonable fee directly to the doctor for the service provided.
Regardless of the practice structure, it’s almost certain that it will include telemedicine visits, which have become more popular as a way to provide quality care for a large number of medical conditions. Most patients with diabetes and hypertension, for example, can be followed through virtual visits and home monitoring. Some forecasters predict that the typical primary care practice might have a 50:50 balance between telemedicine visits and in-person visits. Plus, some health care providers think using their time this way will lighten their workload and, thereby, help prevent burnout.