NEPA Needs More Physicians
Northeast Pennsylvania — and the United States in general — needs more physicians to care for a growing and aging population.
A big part of meeting health care needs is primary care, and Geisinger Health System forecasts Northeast Pennsylvania will face a growing shortage of primary care physicians.
A Geisinger study showed there was a shortage of 38 primary care physicians in 2017 in the region. By 2022, the shortage is forecast to reach almost 200, said Dr. Maria Kobylinski, chair of Community Medicine for the Geisinger Medicine Institute. Those numbers are for all health care providers across the region, not just Geisinger.
“If there’s no handle on that, everything else doesn’t fall into place. We need primary care to make everything else successful,” she said.
There are several factors driving the shortage.
There are more older patients in the region, and older patients need more medical care than younger patients.
As the population ages, so do the providers caring for that population. More doctors are nearing retirement age, and they may reduce the amount of time they are working ahead of a retirement.
Bridging the gap is made more difficult by the fact that other medical specialties pay more, which is attractive to medical students choosing where to focus their practice. For a long time, health care has operated according to a fee-for-service model, in which every procedure has a code with a corresponding fee attached to it.
Primary care physicians must perform counseling on diabetes, weight loss, the end of life, stress, blood pressure, diet and more, and until recently, there were not many codes for those important conversations, Kobylinski said.
“That important conversation is just documented as meeting a patient,” she said.
And many medical students may simply be attracted to work other than the kind performed by primary care physicians.
Consequences of a shortage
When there is a shortage of primary care physicians, the consequences spread through the population. Fewer doctors mean longer waits to see one, and they have less time to do preventative care that would help people from coming down with diseases.
For example, obesity is a growing problem.
“If I can’t see patients when they should lose 10 pounds instead of 20 pounds, they’re more at risk for diabetes or high blood pressure. When someone calls, I want to see them because they need preventative care and lifestyle modifications to stay healthy,” Kobylinski said. “If we wait until a heart attack to say, ‘You should take blood pressure medication and lose 20 pounds,’ that’s too late.”
Not just primary care
Some other health care specialties that will have a shortage in our region include psychiatry, general surgeon, almost all subspecialties in pediatrics, neurologists and urologists.
“That’s just a sampling,” said Dr. Steven J. Scheinman, president and dean of Geisinger Commonwealth School of Medicine in Scranton. “There are very few specialties for which we have an adequate supply.”
Part of the shortage comes from a lack of residency jobs.
Medical schools have grown substantially in the last decade, but the number of residency jobs is growing by about 1% per year, Scheinman said.
“It’s mainly funded by the federal government, and they don’t have a strong appetite to increase expenditures,” he said. “The original draft of the Affordable Care Act had several thousand more doctors in it, but that got trimmed out.”
Mitigating the issue
Hospital systems have been adopting their own strategies to mitigate a physician shortage.
Urgent care clinics have become more common. Patients using those can walk in and see someone for urgent issues that aren’t serious enough to require a visit to an emergency room.
Recruitment is another part of the solution.
For example, Commonwealth Health uses medical education stipends, commencement bonuses, medical education reimbursement, relocation allowances and improved salaries for recruitment, spokeswoman Annmarie Poslock said. The health system has recruited 32 primary care providers over the last five years.
Another strategy is adopting team-based care.
Advanced practitioners such as nurse practitioners and physician assistants, nurses, pharmacists and other healthcare providers will increasingly be used, and reimbursement will move away from a fee-for-service structure toward a system based on patient outcomes, Scheinman said. Medicare reimbursement is moving in that direction, which is driving a change, he said.
“It will be more of managing the patient’s health, not just reacting to episodes of illness,” he said. “That’s a different model from how I grew up and what many of your readers experience.”
Finally, health care providers are making it easier for patients to get health care without visiting a hospital. Changes include techniques such as telemedicine and wearable technology. If those are used well, it allows patients to be seen by a doctor without leaving the house. Another strategy looks to an old symbol of medical service: The house call.
There is a Geisinger program in which a team of health care providers visit patients at their home. Those have reduced the frequency of patient visits to the hospital, reduced costs and improved outcomes.
“Things like that are being pioneered across the country and over time I think they will change the paradigm of care,” Scheinman said.
Contact the writer: