The Association of American Medical Colleges (AAMC) projects a shortage of up to 86,000 physicians by 2036. This includes as many as 40,000 fewer primary care physicians.
This shortage in primary care physicians is a particular concern among more vulnerable patients. As such, Open Door and other FQHCs around the country are already feeling the pinch.
Primary care physicians are often the first point of contact for patients. They are critical in preventing illnesses and injuries from becoming more severe, helping to mitigate chronic conditions, and identifying when more specialized care is needed. Better access to primary care providers leads to better health outcomes.
Dr. Daren Wu, Chief Medical Officer, explains what Open Door is doing to continue to provide quality health care to patients despite the challenging environment.
What are the key points that need to be made about the shortage of primary care physicians?
This is very much a national issue, with significant primary care shortages everywhere, but especially with underserved populations regardless of rural/suburban/urban setting. Conversely, wherever there is more primary care, costs are reduced, and quality of care goes up.
How is Open Door responding to this?
Necessity has helped us adapt to the current situation, which indeed is projected to worsen over time. Our model of care uses a mix of providers and a “bottom up” collaborative, integrative and team approach where all providers work to the top of their skill levels and credentialing. Nurse practitioners and physician assistants work side-by-side with MDs, and medical assistants and front office staff help clinicians maximize their time spent “closing loops” in patient care. When I joined Open Door 25 years ago, I was one of about 20 clinicians organization-wide, and I think there was just 1 NP at the time. Now, we have about 20 doctors, 20 PAs, and 20 NPs, and the third that is comprised of doctors will continue to decline over time as we continue to bring in more NPs and PAs. Our doctors have learned to adapt to being more supportive and prepared to be in a more consultative mode for their NP and PA colleagues.
Are you convinced that the quality of care given by NPs and PAs is equal to those offered by physicians?
Absolutely. While there is a direct correlation between primary care and quality/access, studies show there is NO quality differentiation in primary care between care given by physicians versus that given by NPs and PAs. Primary care is mostly driven by regular preventive (physical) visits and things like acute care (colds, sprains, headaches), so much of the work is pretty straightforward and we won’t see much differentiation there. However, chronic disease care is rising in primary care, and everywhere – including at Open Door – where the sickest patients tend to gravitate towards the care of our physicians.
Do patients come in asking for a doctor or have they gotten to the point where they willingly accept a PA or NP?
I think most of our patients are quite satisfied with our NPs and PAs, who as a group are a skilled and empathic bunch. Our patient satisfaction scores are very high, so evidently most of our patients do not really care if they see a doctor or an NP/PA. Additionally, our nurses – and our medical assistants and patient advocates – greatly contribute as part of our care teams.
