Primary Care Workforce
This guide brings together all the Resources, Organizations, Funding, Events, and News we've discovered related to Primary Care.
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What is primary care and who provides it?
Primary care is comprehensive health care addressing first contact and continuing health care services.
Primary care services include health promotion and disease prevention, diagnosis and treatment of acute
and chronic conditions, chronic disease management, coordination of health care services, patient education
Primary care can also be defined by the professions providing primary care services.
Primary care providers include physicians
trained to provide generalist care as well as nurse practitioners
and physician assistants
specializing in primary care, and some other health care providers who provide primary care services.
When primary care is defined by specialty, family medicine, general internal medicine, and general pediatric
medicine are most often included. Obstetricians and gynecologists are sometimes included and more recently,
specialties like geriatrics and adolescent medicine that provide primary care for a population in a specific
age group. A recent report
commissioned by the Agency for Healthcare Research and Quality estimates about 209,000 physicians,
56,000 nurse practitioners and 30,000 physician assistants are currently practicing primary care.
A couple of reports estimate a lower number of physician assistants.
- Contribution of Primary Care to Health Systems and Health, Starfield B, Shi L, Macinko J, 2005
- Declaration of Alma-Ata: International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, World Health Organization, 1978
- Primary Care Workforce Facts and Stats, Agency for Healthcare Research and Quality, 2012
Why is the primary care workforce important?
Primary care providers act as patient advocates, help coordinate any specialty care needed by their patients,
and through preventive services, help people live longer and healthier lives.
The primary care workforce is of particular concern because of the important role primary care fills in ensuring
comprehensive, cost-effective care. According to the 1996 Institute of Medicine report,
Primary Care: America’s Health in a New Era,
primary care is “essential to reaching the objectives that constitute value in health care: high quality care
(including achieving desired outcomes), good patient satisfaction, and efficient use of resources.”
There are concerns that the primary care workforce is not adequate to meet current and future health care needs.
A report from the National Association of Community Health Centers, The George Washington University School of
Public Health and Health Services, and the Robert Graham Center,
Access Transformed: Building a Primary Care Workforce for the 21st Century,
identified 56 million people without access to needed primary care due to provider shortages.
What are current trends related to the primary care workforce?
Compared to Western peer nations,
the United States has a lower percentage of providers in primary care and that proportion is shrinking.
Currently, about 35% of physicians and 34%
of physician assistants practice in primary care. Additional trends
related to the primary care workforce include:
- Shortages of primary care providers because of:
- Fewer people going into primary care
- Rising demand due to aging population and the Affordable Care Act
- Maldistribution due to declining numbers of providers working in rural and underserved areas
- Increased use of primary care teams
- New ways of providing primary care, such as:
- Patient-Centered Medical Home
- Concierge primary care practices
- Retail clinics
- Increasing compensation gap between specialty and primary care
- Payment reforms that reward primary care providers for improved health outcomes
- Declining scope of practice
What can be done to encourage more health care providers to go into primary care?
Access Transformed: Building a Primary Care Workforce for the 21st Century
notes that “Lower salaries, school debt, heavier workload, and demands on their time are major factors in
medical students’ decisions to enter primary care.” Recommendations for increasing the percentage of health
care providers choosing primary care include:
- Reducing the income gap between primary care providers and specialists.
A number of reports contend that fewer people choose careers in primary care because specialists get paid
much more than primary care providers.
- Reforming the payment structure
may also increase satisfaction with primary care as providers feel less driven by the number of procedures
they provide and can focus more on caring for patients
- System changes that promote health care teams, which increases the workforce providing
primary care and may increase interest in and satisfaction with primary care
- Business training and small business loans to help providers set up and maintain primary care practices, like those offered in
- Primary Care Extension Program
and change facilitators
to help practices transform to new models of care like the Patient-Centered Medical Home
- Educational initiatives that support a service ethic through the admissions process, learning
experiences, mission statements that support primary care,
and locating schools in underserved communities
- Scholarships and loan programs to reduce medical school debt
may encourage more providers to go into primary care
and help people from lower-income families, who are more likely to go into primary care, afford medical school.
- Pipeline programs that increase interest in primary care and help people who are more
likely to go into primary
care get into medical school
- Community based residency programs such as
teaching health centers
may encourage physicians to practice in community-based primary care
For more related resources, see Primary Care narrowed by Specialty Choice.
What skills will primary care providers need to succeed in the future workplace?
A number of reports discuss the skills primary care providers will need in the future, primarily affected
by changes in the health care system such as new models of care, new technology, and changes in demographics.
Future primary care providers will need skills related to:
- Patient-centered care
- Effective communication
- Engaging patients in care decisions
- Consideration of a patients’ broader needs and culture
- Patient education
- Team building
- Performance monitoring
- Constructive feedback
- Shared decision making
- Understanding of the health care system
- Sensitive to how their decisions affect the cost and effectiveness of the health care system
- Coordination of behavioral health, oral health, and primary care
- Commitment to quality
- Quality improvement (QI) principles
- Lifelong learning
- Evidence-based practice
- Effectively incorporate the capabilities of new technologies, like electronic health records
- 7th Annual Report to the Secretary DHHS and to Congress: Coming Home: The Patient-Centered Medical-Dental Home in Primary Care Training, Advisory Committee on Training in Primary Care Medicine and Dentistry, 12/2008
- 8th Annual Report to the Secretary DHHS and to Congress: The Redesign of Primary Care with Implications for Training, Advisory Committee on Training in Primary Care Medicine and Dentistry, 5/2010
- Core Competencies for Interprofessional Collaborative Practice, Interprofessional Education Collaborative, 5/2011
- Core Principles & Values of Effective Team-Based Health Care, IOM Roundtable on Value & Science-Driven Health Care, 10/2012
- Five Prescriptions for Ensuring the Future of Primary Care, American College of Physicians, 10/2010
- Who Will Provide Primary Care and How Will They Be Trained?, Josiah Macy Jr. Foundation, 4/2010
How will the Patient Protection and Affordable Care Act affect the primary care workforce?
While most agree that additional policy reform is needed to transform and expand the primary care workforce,
the Affordable Care Act contains several elements addressing primary care. The ACA is
- Offer new payment models that reward primary care providers for improved health outcomes
- Provide a temporary ten percent
primary care bonus under Medicare
- Temporarily increase primary care rates for Medicaid to Medicare levels
- Support models of care that emphasize primary care like patient-centered medical homes
- Offer more community-based training options like teaching health centers, helping encourage more people to go into primary care
- Increase demand for primary care as more patients will have insurance coverage, exacerbating the shortage
of primary care providers, particularly for Medicaid patients
- Increase the supply of primary care providers, particularly in underserved areas
Future legislation and regulations could change these provisions. For more information, see Health Reform.
Page last updated December 20, 2012