Co-authored by: Logan Pike & Matthew Glans
Decades of overregulation of the health-care labor market, an aging population and the implementation of the Affordable Care Act have created a shortage of primary-care doctors nationwide.
This isn’t a problem that has snuck up on lawmakers. Even before the ACA’s passage, many states faced the prospect of a doctor shortage. In 2011, a study published in the Milbank Quarterly found the ACA would create a need for between 4,300 and 7,000 more physicians in the United States by 2019.
A new report suggests the Milbank authors were correct about the looming shortage of primary-care physicians, especially in the state of Florida. The Robert Graham Center estimates Florida alone will need an additional 4,671 primary-care physicians by 2030 (based on the 2010 figure of 12,228 primary-care physicians) to accommodate the rising need for health-care services.
Some efforts are already underway in Florida to help fix this growing problem. On April 15, Gov. Rick Scott signed a bill making Florida the last state to allow advanced nurse practitioners and physician assistants to prescribe certain controlled substances. This will significantly decrease the demand currently placed on many primary-care doctors.
A 2014 survey by the Physicians Foundation found most doctors have little or no room to add patients, with 81 percent of physicians describing themselves as “either over-extended or at full capacity.” Only 19 percent of the respondents “indicate they have time to see more patients.” The report also found 44 percent of physicians surveyed plan to take steps that would reduce patient access to their services, including “cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking nonclinical jobs.”
Strict licensing standards have become a significant barrier to entry in many fields, but nowhere is the influence of licensing more sharply felt than in the health-care industry. Supporters of strict state licensing standards argue they assure quality, but critics say the arduous and often expensive licensing process harms the health-care market by hindering entry for new physicians, thereby impeding the market competition needed to lower costs and improve access for patients.
There are several paths Florida legislators and medical boards can choose to lower regulatory barriers in the health-care industry to reduce the physician shortfall. The first proposal, recently introduced as model legislation by the Federation of State Medical Boards, would make it easier for doctors licensed in one state to treat patients in another.
Reporter Robert Pear wrote in The New York Times that this reform would not only cover in-person visits but also videoconferencing and online visits. The proposed legislation would create an interstate compact, and the Times reports it has political support from both sides of the aisle.
The second proposal, supported by the Institute of Medicine and National Governors Association, would further expand the scope of responsibilities for nurse practitioners, allowing them to provide additional health-care services. These additional services would include expanding the scope of practice to services like the initial evaluation of new symptoms, ongoing care for chronic diseases and preventive services, such as immunizations and screenings. This extension would only apply to registered nurses who have also received a graduate degree in nursing. Allowing nurse practitioners to administer care would greatly reduce the doctor shortage and increase access to care.
Currently, 19 states and the District of Columbia allow nurse practitioners to diagnose and provide some form of treatment for certain illnesses. Although critics of these efforts claim expanding the scope of practice will lower the overall quality of care, a 2012 article in Health Affairs reviewing 26 studies noted the “health status, treatment practices, and prescribing behavior [of NPs] were consistent between nurse practitioners and physicians.”
Further, according to research from the Mercatus Center at George Mason University, the average American would rather see a nurse practitioner or physician assistant than wait to see a primary-care physician. But nurse practitioners and physician assistants cannot serve as practical alternatives when they lack the authority to prescribe controlled substances.
In a time when many health-care-policy debates at the state level are gridlocked, there are still policies that would improve access to care without increasing costs or decreasing quality. Allowing physicians to treat patients across state lines and expanding the scope of practice of nurse practitioners are two incremental steps Florida can take to address the doctor shortage.