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- Page navigation anchor for The shortage is probably even greater than stated dt unmet needsThe shortage is probably even greater than stated dt unmet needsShow More
The US is unique among OECD nations in its proportion of primary care physicians (PCPs) as well as higher costs and poorer outcomes. The US has about 30% primary care; most other nations have a more desirable 50% ratio. Bringing the US into line with other OECD nations would increase the need by approximately 150,000 PCPs to meet the real primary care needs of the US population.
Other estimates of current short...
Competing Interests: None declared. - Page navigation anchor for Workforce Needs: Musings of a Resident PhysicianWorkforce Needs: Musings of a Resident PhysicianShow More
Petterson et al. have provided a sobering portrayal of the upcoming primary care workforce needs in the United States. Although the writers project an additional 52,000 primary care providers needed by 2025, they mention a large proportion of these providers will be needed in the years 2014 and 2015, when the Affordable Care Act (ACA) is enacted (1). Given the fast approaching increase in patients, and corresponding ne...
Competing Interests: None declared. - Page navigation anchor for Gratitude for Enhanced Workforce EstimatesGratitude for Enhanced Workforce EstimatesShow More
These evidence-based estimates are another example of "statistical compassion," via empirically-based arithmetic. The conservative assumptions made are prudent and align with/improve prior work. In short, this is a serious contribution that merits national attention in the cacaphony of calls for MORE physicians and just about every other type of clinician.
In addition to answering the questions posed for the...
Competing Interests: None declared. - Page navigation anchor for Primary care needs and the ACAPrimary care needs and the ACAShow More
Petterson et al's article is an excellent addition to the literature assessing future primarycare workforce needs. Using the MEPS visit rates and parsing out growing demand for physician care into the bins of population growth, aging, and the ACA is a useful contribution to the literature, as is the careful description and accounting of the current primary care physician workforce. With regards to the latter, work usin...
Competing Interests: None declared. - Page navigation anchor for Author response: Re:Primary Care Providers IIAuthor response: Re:Primary Care Providers IIShow More
Hi Dr. Kelly, In response to your other comment about the type of provider seen by the patient, we used this question to identify the specialty of the physician. It is from the medical visit section of the questionnaire (for 2008: http://meps.ahrq.gov/survey_comp/hc_survey/2008/MV1201.pdf)
The question (MV03A) is "What was the doctor's specialty?" We considered primary care visits as visits to general practition...
Competing Interests: None declared. - Page navigation anchor for Author response: Primary Care ProvidersAuthor response: Primary Care ProvidersShow More
Dr. Kelly, Thanks for your response. We agree that NPs and PAs play an important role in delivering primary care. We also agree that projecting their utilization is an important aspect of answering our study's question.
We actually had a paragraph in the original discussion section about NPs and PAs (and about how we were unable to directly project their utilization using the AMA Masterfile which only tracks phy...
Competing Interests: None declared. - Page navigation anchor for Primary Care Providers IIPrimary Care Providers IIShow More
As an addendum to my first comment, the patient self-identification of a primary care visit in the MEPS survey occurs by answering the following question:
"In the last 12 months, not counting the times you went to an emergency room, how many times did you go to a doctor's office or clinic to get health care for yourself?"
The type of provider seen is not specified. Especially in Federally Qualified He...
Competing Interests: None declared. - Page navigation anchor for Primary Care ProvidersPrimary Care ProvidersShow More
I was surprised to make it to the last paragraph of your manuscript without any mention of other primary care providers (PAs/NPs). The MEPs data look at physician office visits. Substantial numbers of primary care office visits are conducted by PAs/NPs without direct physician involvement. Some studies have calculated that close to 25% of primary care visits in many areas are conducted by non-physician primary care...
Competing Interests: None declared.