Right Now

On November 29, 2013, Mary Wakefield, the director of the Health Resources and Services Administration at HHS replied to the letter Dr. Coburn (along with Sen. Burr and Enzi) sent her on November 1, 2013. Their original letter followed up on the findings of GAO’s report (GAO-13-806), which the Senators said showed HRSA had failed to provide Congress and the public with timely and meaningful analysis regarding health care provider shortages across our country. As the Senators noted in their letter, they were “gravely troubled by the findings” of the report, and therefore requested a series of documents from HRSA on the matter.  

HRSA Director Wakefield’s letter included responses (see here and here) to a number of specific items the Senators had requested, as well as references to a new HRSA study issued as a result of the Senators’ oversight work. The new study, “Projecting the Supply and Demand for Primary Care Practitioners Through 2020,” was issued by HRSA’s Bureau of Health Professions National Center for Health Workforce Analysis. 

The new study found that the country will be about 20,400 primary carephysicians short by 2020. HRSA’s study cites “aging and population growth” as accounting for 80 percent of the change in demand, but they also say 20 percent of the demand is due to the Patient Protection and Affordable Care Act/Obamacare. So, while Obamacare is not the sole cause of the coming primary care physician shortage, the provisions of the law will exacerbate the shortage.

A methodological limitation of the study noted by some is that “the model assumes continuation of key trends in service utilization, practitioner practice patterns, and practitioner production.” In other words, the study is a straight line projection of current supply and demand for physicians, and does not assume any changes in delivery system innovation, payment, or utilization. This is a notable limitation, since changes in physician practice patterns, payments, and utilizations continue to evolve each year.  Certainly, there will be changes to a number of dynamics impacting physician utilization between now and 2020.

However, while the methodological approach is a limitation of the study’s findings, it is a relatively small limitation and should not be read to negate the study’s findings.  In fact, many observers have argued that this straight line projection of current supply and demand is actually the best way to project physician shortages for 2020, since that date is in the relative near term, just about six years away.  (This approach contrasts with other workforce shortage projection which forecast supply and demand over a longer time horizon and therefore increase the uncertainty of those projections).

Finally, as the study notes, the primary care physician shortages could be worse in some places across the country. “The national averages reported here mask substantial distributional disparities across the United States,” the report warns. Additionally, some underserved localities could see a greater need for various specialties as well.