Global Library of Women's Medicine
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Figure 1: Areas not in yellow represent primary care shortage areas. HPSA = health professional shortage area.
Image prepared by: HRSA, Office of Information Technology from the HRSA Data Warehouse, datawarehouse.
PCP and Mental Health Providers
Primary care providers (PCPs) are essential for comprehensive, long-term, patient-centered care. They are the patient’s first point of contact with the healthcare system and are responsible for coordinating treatments among other professionals. In recent years, the US has seen a significant decline in the number of PCPs, as well as diminished access to preventive care and deteriorating primary care infrastructure. Mental health is an often overlooked but vital part of healthcare. More than half of the US population suffers from mental illness during their lifetime. Both mental health and primary care provider shortages have been attributed to inadequate reimbursements, comparatively low income, and overwhelming patient and documentation loads. PCPs also face a high rate of burnout, and after years of practice, some choose to pursue other specialties. The introduction of universal coverage in Massachusetts highlighted that the severe lack of PCPs needs to be addressed before patients who are newly insured by the Affordable Care Act can access care.
Fee-for-service compensation pays much more for concrete, specialty-delivered procedures than for primary care and mental health services such as counseling and psychotherapy.
Dentist Shortages
Millions of Americans, especially vulnerable populations like children and members of underserved communities, don’t have access to basic dental health care. Additionally, many older dentists that belong to the “baby boomer” generation are reaching retirement age. In 2011, the Institute of Medicine (IOM) released a report urging states to expand dental Medicaid to adults and increase reimbursement rates for oral care. In a controversial move, the IOM also recommended that states allow dental hygienists, assistants and non-dental professionals to provide dental treatments and oral health screenings. Allowing other health professionals to provide dental care is a contentious issue, because there is little evidence that this will extend services and preventive care to the populations that need it most.
Alaskan Experience
Alaska, a state that faces a severe dentist shortage, began a program to train lay people to extract teeth and fill cavities in order to provide care to the state’s remote villages and tribes. The ADA criticized and even sued the program, expressing concern that the newly minted “dental therapists” will harm patients. In 2010, the Kellogg Foundation released a study showing that Dental Health Aide Therapists in Alaska provide safe and appropriate care under dentist supervision, resulting in great patient satisfaction. However, disquiet remains over defining an appropriate scope of practice for dental hygienists and aides.
Providing Care Despite the Shortages
Underserved populations in rural and urban areas are most affected by chronic provider shortages. Along with the shortages described above, these areas have fewer RNs, specialists, and other health professionals. Medical homes are an innovation geared to improve primary care access where non-MD health professionals take on roles such as lifestyle modification, medication counseling, and patient education. Communication technology is a way to improve access for remote areas. For example, physical therapists guide patients via telemedicine, and rural physicians consult with specialists and pharmacists in large medical centers by phone. Nurse Practitioners and Physician Assistants are also beginning to serve as direct-access primary care providers in face of the continued challenge of physician shortages.
Table 1: Graduates with higher debt are more likely to pursue high-income specialty professions that offer a better lifestyle over primary or mental health care.
|Average salary in 2009 |
|Family Physician |$173,000 |
|Psychiatrist |$192,292 |
|General Surgeon |$330,000 |
|Plastic Surgeon |$412,000 |
|Average graduating medical |
|student’s debt |
|$157,944 |
Provider Shortages
Primary Care, Dental and Mental Health Provider Shortages in the US
Section 3022 of the Patient Protection and Affordable Care Act
Health Policy Fact Sheet
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