Federal policymakers have long sought to add more primary care providers to the understaffed workforce. region.Biden administration Increase in funds In 2022 to address the shortage, Sen. Bernie Sanders (I-Vt.) promoted radical primary care legislation In 2023.
But when KFF Health News tried to map where primary care workforce shortages actually are and aren’t last year, we encountered spotty data and a lack of better information. Many people have told us that it’s hard to know which one is missing because of this. The policy is working. After all, consistent national data is a pipe dream.
We analyzed existing federal government data. official list “Scarcity Areas” created to help concentrate primary care health workers where they are needed most. We found that more than 180 regions have remained on the primary care shortage list for at least 40 years.
Here is the map:
“No government agency is tracking who trained where and what, and who is now practicing where and what.”Said Alison Hufstetlermedical director of robert graham center, a Washington think tank focused on primary care. “Without knowing who is providing what care, where, and what, there is no way to manage patient-to-physician ratios equitably across all states.”
Scarcity areas have plenty of carrots to attract health care providers, including federal student loan repayments. Bonus Medicare payments Expedited visa for foreign clinicians.
The fact that regions on the physician shortage list are underperforming is not because the supply of physicians is dwindling.by Federation of State Medical BoardsThe number of licensed physicians in the United States more than doubled to more than 1 million from 1990 to 2022, outpacing the overall population growth.
a health problems The research results, published in November, Federal designation. This helps in allocating estimated amounts. 1 billion dollars Funding annually through at least 20 federal programs aimed at improving primary care capacity has failed to significantly increase the ratio of health care providers to the population.
One possible reason why shortage areas persist is that the incentives are too small or too short-term, he said. Justin Murkowski, Yale School of Public Health PhD student and co-author of a health issues study.
But another important question is how to measure the shortage.
That’s up to state health officials. Determine population and location It may be identified as a deficiency area; Please submit to Management of health resources and servicesWhich then scoredegree of deficiency. These state agencies vary in funding and staffing, creating an uneven base.
Additionally, the physician-population ratio, the main indicator for identifying shortage areas, has obvious weaknesses. It only takes into account physicians, not countless other medical professionals such as physician assistants and nurses. provide They are responsible for the majority of primary care in our country.
Take Costilla County in southern Colorado, for example.. It was deemed a primary care deficit area in 1978 and has remained on the list ever since. Certainly, the region could hire more clinicians. However, it is also true that federal data overlooks providers such as: teeth That includes nurses who drive in once a week from the nearest city to see patients, and physician assistants who immigrated from Texas to fill a more permanent gap.
Since 1998, federal officials have made three attempts to update the 1970s-era rules defining scarcity areas. Just recently, the authors of the Affordable Care Act created a panel of experts to solve it.
When that failed, Colorado came up with another method. Unique medical professional shortage area designationwhich includes nurse practitioners and physician assistants.
“It’s critically important for the nation to focus resources on the communities with the greatest need.” ed salsbergwas the lead federal representative on the commission established by the ACA and head of HRSA. National Center for Health Care Workforce Analysis. “The time has come to take another shot at developing improved methodologies.”
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