Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage

Originally published as NIHCR Policy Analysis No. 7 by the National Institute for Health Care Reform (NIHCR). Authors: Emily Carrier, Tracy Yee, Lucy B. Stark. NIHCR was affiliated with the Center for Studying Health System Change (HSC), a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage

The United States faced a growing shortage of primary care physicians that threatened to limit access to basic health services for millions of Americans, particularly as the Affordable Care Act expanded insurance coverage to previously uninsured populations. This policy analysis examined the dimensions of the primary care workforce gap and evaluated strategies for matching supply to demand.

The Dimensions of the Shortage

The primary care workforce shortage stemmed from multiple converging factors. Fewer medical school graduates were choosing primary care residencies, drawn instead to higher-paying specialties. The existing primary care workforce was aging, with a wave of retirements on the horizon. Meanwhile, demand for primary care was growing -- driven by an aging population, rising chronic disease prevalence, the ACA coverage expansion, and a growing body of research showing that strong primary care systems produce better health outcomes at lower cost. Geographic maldistribution compounded the problem: rural and inner-city communities already facing physician shortages were expected to experience the greatest access challenges.

Strategies for Closing the Gap

The analysis examined several approaches to addressing the shortage. On the supply side, options included expanding medical school enrollment, increasing the number of primary care residency positions, offering loan forgiveness and scholarship programs to attract graduates to primary care, and supporting the National Health Service Corps. On the demand side, strategies focused on using primary care resources more efficiently through team-based care models, expanded scope of practice for nurse practitioners and physician assistants, greater use of telehealth and electronic consultations, and redesigned payment systems that better compensated primary care relative to specialty services. The patient-centered medical home model, which reorganized primary care around coordinated, team-based delivery, showed particular promise for stretching available primary care capacity while improving quality.

Sources and Further Reading

This Policy Analysis was published by the National Institute for Health Care Reform (NIHCR). The research was conducted by Emily Carrier, Tracy Yee, and Lucy B. Stark. Data sources included the Association of American Medical Colleges physician workforce projections, the Health Resources and Services Administration, and HSC's Community Tracking Study findings on primary care access across 12 metropolitan communities.