The Medicare Payment Advisory Commission (MedPAC) notes that there is a primary care shortage that should be addressed before it becomes acute.  This report notes that although the absolute number of primary care physicians billing Medicare increased from 169,640 in 2011 to 184,905 in 2016, the ratio of primary care doctors to beneficiaries decreased, from 3.8 per 1,000 beneficiaries in 2011 to 3.5 in 2016, and a similar trend also occurred in other specialties. 

That decrease doesn’t seem to have affected Medicare enrollees’ access to care, however. In 2017, according to a MedPAC survey, enrollee access to physicians was comparable to or better than that of privately insured patients ages 50-64. Only a small share of enrollees reported having any trouble finding a doctor, although among those who did, more of them had trouble finding a primary care doctor than a specialist.

The commission should think hard about what the ideal makeup of health system should be, said one member. “In 12 years, the number of Medicare beneficiaries is going to increase by 15%; how are we getting our care?”  She went on to speculate that maybe what’s needed is to have beneficiaries see a nurse practitioner or physician assistant for most visits, but have a geriatrician available if they get really sick. She wondered "what should we be thinking about paying nurse practitioners and physician assistants; how many do we want to encourage? Should there be a loan forgiveness program [for them]?”

During a session discussing the ways Medicare could help increase the primary care physician supply, members noted that “It seems silly that a person working as a PA successfully for years [who wants to become a doctor] has to go to medical school and start from scratch.” Instead, allopathic and osteopathic medical schools could develop “degree completion” programs that take into account the PAs’ medical experience.

“Maybe a way to think of this topic is not just scholarships and loans, but policies that impact directly on primary care practitioners,” said MedPAC commissioner Paul Ginsburg, PhD, chair of health policy studies at the Brookings Institution.

Perhaps the chiropractic community needs some form of “physician finalization” program in the future, one that would qualify a graduating or licensed doctor of chiropractic to be tested and licensed by medical boards.

Likewise, perhaps the chiropractic community needs some form of “physician finalization” program in the future, one that would qualify a graduating or licensed doctor of chiropractic to be tested and licensed by medical boards.  Being licensed as a “primary care physician” in states like Texas that require licensure by the medical board to be considered a “physician” would go a long way towards meeting the worried-about physician shortage.

 In other states where DCs are already considered “physicians”, such a program would enhance the doctoral training already received by the doctor of chiropractic, serving to enhance their practices.

Source:  https://www.medpagetoday.com/publichealthpolicy/medicare/75538