Expanding Physician Capacity Association of American Medical Colleges, in Washington, D.C., and an doi: 10.1377/hlthaff.2013.0539 assistant professor at the HEALTH AFFAIRS 32, Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire. NO. 11 (2013): 1990–1997 ©2013 Project HOPE— Christine A. Sinsky is a physician at Medical The People-to-People Health Associates Clinic and Health Plans, in Dubuque, Iowa. Foundation, Inc. By Scott A. Shipman and Christine A. Sinsky ANALYSIS COMMENTARY & Expanding Primary Care Capacity By Reducing Waste And Improving The Scott A. Shipman (sshipman@ Efficiency Of Care aamc.org) is director of primary care affairs and workforce analysis at the n 2014 the United States will improve equity primary care physician workforce shortage will not in health care access by expand- ing health translate into increased access to care. insurance coverage to mil- lions of previously Common approaches proposed to ameliorate the uninsured citizens through the projected shortage of primary care physi- cians can be implementation of provi- divided into the following three imperatives: train trial of the Affordable Care Act. Recent popular debate more, lose fewer, or find someone else. This about the insurance expansion has prin- cipally focused commentary articulates the need to look beyond those on its political consequences and cost implications. approaches and pur- sue a fourth tack: waste less. To Less attention has been paid to the capacity of the demonstrate the potential of reducing waste and health care workforce to accommodate the anticipated inefficiency, we review evidence of many influx of newly in- sured Americans, although health in- efficient activities that greatly diminish reform has underscored concerns about the adequacy of the ca- pacity of today’s primary care workforce. the primary care workforce. Indeed, even before Finally, we present solutions to inefficiencies that we passage of the Affordable Care Act—which in- cludes have observed through site visits and related contacts provisions to strengthen primary care— many groups with leaders of innovative pri- mary care practices had predicted a shortage of primary care physicians in across the country. These observations stem from our the United States.1–3 Expanded access to insurance in separate profession- al efforts through the Association the midst of a of American 1990 Hea lth A ffairs November 2013 32 :11
Expanding Physician Capacity doi: 10.1377/hlthaff.2013.0539 HEALTH AFFAIRS 32, NO. 11 (2013): 1990–1997 ©2013 Project HOPE— The People-to-People Health Foundation, Inc. Scott A. Shipman (sshipman@ aamc.org) is director of primary care affairs and workforce analysis at the Association of American Medical Colleges, in Washington, D.C., and an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire. Christine A. Sinsky is a physician at Medical Associates Clinic and Health Plans, in Dubuque, Iowa. By Scott A. Shipman and Christine A. Sinsky ANALYSIS & COMMENTARY Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care n 2014 the United States will improve equity in health care access by expand- ing health insurance coverage to mil- lions of previously uninsured citizens through the implementation of provi- of the Affordable Care Act. Recent popular debate about the insurance expansion has prin- cipally focused on its political consequences and cost implications. Less attention has been paid to the capacity of the health care workforce to accommodate the anticipated influx of newly in- sured Americans, although health reform has underscored concerns about the adequacy of the primary care workforce. Indeed, even before passage of the Affordable Care Act—which in- cludes provisions to strengthen primary care— many groups had predicted a shortage of primary care physicians in the United States.1–3 Expanded access to insurance in the midst of a primary care physician workforce shortage will not translate into increased access to care. Common approaches proposed to ameliorate the projected shortage of primary care physi- cians can be divided into the following three imperatives: train more, lose fewer, or find someone else. This commentary articulates the need to look beyond those approaches and pur- sue a fourth tack: waste less. To demonstrate the potential of reducing waste and inefficiency, we review evidence of many in- efficient activities that greatly diminish the ca- pacity of today’s primary care workforce. Finally, we present solutions to inefficiencies that we have observed through site visits and related contacts with leaders of innovative pri- mary care practices across the country. These observations stem from our separate profession- al efforts through the Association of American 1990 Hea lth A ffairs November 2013 32 :11 trial
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