Growing the supply of primary care providers

With the passage of the Patient Protection and Affordable Care Act (ACA) many uninsured Oklahomans will have access to health insurance coverage starting in 2014. The influx of newly insured Oklahomans will create a greater demand for health care services. This could cause potential problems in Oklahoma because of the current lack of primary care providers (PCPs) in the state. Oklahoma currently ranks 49^th in access to primary care physicians with only 81.7 physicians per 100,000 people.

Back in August, OK Policy released a Health Care Actions Item Brief that introduced smart policy reforms to improve Oklahoma’s health outcomes. The brief suggested that growing the supply of PCPs would be one way Oklahoma could work towards creating healthier citizens. Increasing PCPs can be accomplished through prioritizing investments to keep primary care physicians in the state, expanding training and scope of practice for non-physician health care providers, and taking advantage of federal funding to increase the health care workforce.

Prior to the passage of the ACA, Oklahoma was already experiencing a shortage in the health care workforce. A report published by the Oklahoma Department of Commerce back in 2005 acknowledged chronic shortages with respect to nursing and allied health professionals and projected that the shortage would steadily worsen by 2012 if action wasn’t taken.       

In response to the foreseen health care workforce shortages, the Oklahoma Health Care Workforce Center (OHCWC) was created. The OHCWC 2010 action plan focused on education and training, health careers recruitment, and public awareness. Unfortunately in 2012, chronic shortages still remained in the health care workforce.   

Oklahoma has to do more to recruit, train, and retain PCPs, especially to serve in rural and underserved communities. A recent Oklahoma Watch article chronicled a rural doctor’s perspective as to why physicians would rather practice in urban cities than in rural areas:

Most new graduates want to get a job where it is nine-to-five, no responsibility after hours, nobody to call them and nobody to bother them, so they are not interested…In a small town, you have to do everything. Some new doctors, they just don’t want that life.

With respect to primary care physicians, Oklahoma has been working to attract these providers to rural and urban settings by providing scholarships and loan forgiveness programs. Additional funding has been provided as well to create primary care residencies through the Oklahoma State University College of Osteopathic Medicine. OSU has also started actively recruiting rural high school students to become interested in the medical field and setting up hometown practices.

Expanding the scope of practice of non-physician providers is another way Oklahoma can grow the supply of PCPs. Physician Assistants (PAs) and Certified Nurse Practitioners (CNPs) can be trained at a lower cost and in a shorter timeframe and provide many of the same basic health care services as primary care doctors. Oklahoma has a broad scope of practice for both PAs and CNPs compared to other states, but the scope of practice for CNPs could be further expanded to allow them to prescribe prescription drugs and order physical therapy.

Some physicians have pushed back on expanding the scope of practice for non-physician providers. Instead embracing the Patient-Centered Medical Home (PCMH) model that facilitates a team-based approached to providing primary care. The Oklahoma Health Care Authority introduced this concept for their SoonerCare Choice members back in 2010. 

With Oklahoma’s current primary care provider ranking, as well as its overall poor health outcomes, an argument could be made that embracing both the expansion of scope of practice for PAs and CNPs and encouraging more health care providers to introduce patient-centered medical homes would be beneficial, especially for our rural and underserved communities.

Oklahoma could also access federal funds to increase the number of PCPs. Title V of the Affordable Care Act addresses the national health care workforce shortage by providing funding and resources to increase the supply of health care workers.  This funding can assist states to develop recruitment strategies, provide scholarships and loan repayment programs to increase the number of health care providers, and fund construction and expansion of community health centers. By accessing these funds, Oklahoma can not only fund more primary care residency programs in areas where they are needed most, but it can also continue to invest in technologies such as telemedicine to create even more access to PCPs.

In order to meet the need of the some 200,000 people expected to get health insurance in 2014, Oklahoma must increase its efforts to provide attractive incentives for PCPs to practice in rural and underserved communities, expand capacity of training programs in order to produce more PCPs, as well as other health care workers, and seek additional resources outside of the state to fund these endeavors.