Supply of Primary Care Professionals Increased; Little Data Available on Minority Representation

In recent years, the supply of primary care professionals increased, with  the supply of nonphysicians increasing faster than physicians. The  numbers of primary care professionals in training programs also  increased. Little information was available on trends during this period  regarding minorities in training or actively practicing in primary care  specialties. Number of Primary Care Professionals in U.S. Training Programs Increased from 1995 to 2006

For two groups of primary care professionals—physicians and nurse  practitioners—the number in primary care training has increased in recent  years. Comparable information for physician assistants and dentists  was not available. Other demographic characteristics of the primary care workforce have  also changed in recent years. Few projections have focused on the likely  supply of primary care physician or nonphysician primary care  professionals. Few Projections Address Future Supply of Primary Care Professionals

Despite interest in the future of the health care workforce, few projections  directly address the supply of primary care professionals. Recent  physician workforce projections focus instead on the supply of physicians  from all specialties combined. Using these factors, HRSA calculated two estimates of future workforce  supply. Move Toward Primary Care Medicine, A Key to Better Quality and Lower Costs, Is Impeded by Health Care System’s Current Financing Mechanisms

Health professional workforce projections that are mostly silent on the  future supply of and demand for primary care services are symptomatic of  an ongoing decline in the nation’s financial support for primary care  medicine. Ample research in recent years concludes that the nation’s over  reliance on specialty care services at the expense of primary care leads to  a health care system that is less efficient. At the same time, research  shows that preventive care, care coordination for the chronically ill, and  continuity of care—all hallmarks of primary care medicine—can achieve  better health outcomes and cost savings. However, some  physician organizations—seeking to reemphasize primary care services— are proposing a new model of delivery. Several findings on the benefits of primary care medicine raise concerns  about the prudence of a health care payment system that undervalues  primary care services.
Why GAO Did This Study

Most of the funding for programs under title VII of the Public Health Service Act goes toward primary care medicine and dentistry training and increasing medical student diversity. Despite a longstanding objective of title VII to increase the total supply of primary care professionals, health care marketplace signals suggest an undervaluing of primary care medicine, creating a concern about the future supply of primary care professionals--physicians, physician assistants, nurse practitioners, and dentists. This concern comes at a time when there is growing recognition that greater use of primary care services and less reliance on specialty services can lead to better health outcomes at lower cost. GAO was asked to focus on (1) recent supply trends for primary care professionals, including information on training and demographic characteristics; (2) projections of future supply for primary care professionals, including the factors underlying these projections; and (3) the influence of the health care system's financing mechanisms on the valuation of primary care services. GAO obtained data from the Health Resources and Services Administration (HRSA) and organizations representing primary care professionals. GAO also reviewed relevant literature and position statements of these organizations.

What GAO Found

In recent years, the supply of primary care professionals increased, with the supply of nonphysicians increasing faster than physicians. The numbers of primary care professionals in training programs also increased. Little information was available on trends during this period regarding minorities in training or actively practicing in primary care specialties. For the future, health professions workforce projections made by government and industry groups have focused on the likely supply of the physician workforce overall, including all specialties. Few projections have focused on the likely supply of primary care physician or other primary care professionals. Health professional workforce projections that are mostly silent on the future supply of and demand for primary care services are symptomatic of an ongoing decline in the nation's financial support for primary care medicine. Ample research in recent years concludes that the nation's over reliance on specialty care services at the expense of primary care leads to a health care system that is less efficient. At the same time, research shows that preventive care, care coordination for the chronically ill, and continuity of care--all hallmarks of primary care medicine--can achieve improved outcomes and cost savings. Conventional payment systems tend to undervalue primary care services relative to specialty services. Some physician organizations are proposing payment system refinements that place a new emphasis on primary care services.