Primary Care Reports

"Dr. John Geyman has written another tour de force on a health care topic. This time he examines the 'silent crisis' which is rapidly unfolding in health care delivery: the unraveling and decline of the primary care structure."

"The next few years of health reform in the United States will witness the influx of millions of new patients seeking health care. Primary care providers (PCPs) are in the best position to deliver care to the millions of new patients entering the health system. However, not enough providers are in place in the United States to meet even existing demands for services."

This paper includes: new empirical research on rural versus urban, quality of care; new projections for rural Medicaid and insurance exchange 2014 coverage expansions; new state-by-state and county-level analysis of future pressure on primary care capacity; new models for rural care delivery and care coordination; and, new national consumer and primary care physician survey data.
 

For the second year in a row, more U.S. medical school seniors will train as family medicine residents, according to new data released today by the National Resident Matching Program (NRMP). The number of U.S. seniors matched to family medicine positions rose by 11 percent over 2010. In Match Day ceremonies across the country today, these individuals will be among more than 16,000 U.S. medical school seniors who will learn where they are going to spend the next three to seven years of residency training.

Studies demonstrate that Pennsylvania needs to take steps now to ensure an adequate supply of physicians on an ongoing basis. Physician workforce levels in Pennsylvania are not nearly sufficient to meet the increase in demand for physician services that will result from our aging population and increased insurance coverage.
 

"The precipitous decline in student interest in the field of family medicine over the past decade is exacerbating the crisis posed by the persistent shortage of providers in rural areas of the United States. Family physicians are the foundation of the rural health care system, with generalists accounting for almost half of rural physicians."

"The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion."

"In January 2010 the Josiah Macy, Jr. Foundation convened a conference to address complex issues concerning who will provide primary care and how they will be trained. Participants developed the set of conclusions and recommendations found in this Executive Summary."

"There are not enough primary care providers to meet current needs. We will need targeted policy changes to ensure that we are well-positioned to provide services to the additional millions of Americans who will have health insurance under health care reform. Massachusetts provides a case in point; the state passed universal coverage in 2008, and there is now concern that there are not enough basic health services providers to accommodate the newly insured. The main reason for this shortage is that medical students do not generally choose to work in primary care. This has been a longstanding and worsening issue; the number of medical school graduates entering family medicine residencies dropped by 50 percent between 1997 and 2005."