America is facing a shortage of primary care physicians. In recent years advanced specialties have become more appealing than ever to medical students because specialists can make triple that of primary care physicians. This is alarming as the aging population will create a skyrocketing need for primary care. According to the Census Bureau, 13.0% of Americans were over the age of 65 in 2010 and that percentage will increase to 20% by 2030. Unless we can increase the supply of primary care, there will not be enough providers to meet the growing demand.
The National Health Service (NHS) of England faced a similar dilemma eight years ago. Primary care doctors were poorly paid; used outdated technology; and had low professional status. As a result medical students had little incentive to choose primary care. In response NHS developed a program designed to measure and reward the quality of private practices. Quality Outcomes Frameworks (QOF) judged the quality of services and made additional payments to the good physicians. The initiative had optimal results on care quality, competition and students’ motivation to choose primary care.
Contrastingly, The Obama administration addressed the US’s shortage via the Primary Care Residency Expansion in 2010, to supplement the education of primary care students. While providing more funding for education may be part of the solution, it fails to address the misaligned incentives driving students away from primary care. Instead, greater financial rewards for the best primary care physicians would make the career choice more appealing.
Wellpoint Insurance is leading the way with an initiative to reward their physicians by adding incentives for primary care doctors, which will increase total payouts by $1 billion. Rewarding primary care providers for high-quality care will not only boost primary care physicians’ earnings and help drive more students into that area, but better primary care has the potential to save insurance companies money via fewer hospitalizations. It’s a good move for public health and for the bottom line.
By Kristen Hayford and Emily Egan