After hearing for years that there were too many specialists and not enough primary care physicians, research in Health Affairs has upset the apple cart by forecasting an insufficient number of specialists to meet the needs of an enlarging elderly population with multiple chronic conditions.
The escalating aging population combined with their associated chronic diseases and the expanded coverage of the Affordable Care Act will drive an increase in demand for adult primary care services by 14 percent between 2013 and 2025 – and ultimately more specialized care – according to a study published in the November issue of Health Affairs.
[See also: Moving beyond scope of practice]
The population over 65 years will grow by close to 45 percent, while the population as a whole by 9.5 percent between this year and 2025. Chronic diseases will rise with this population. Those with cardiovascular disease and with a history of stroke or heart attack are projected to increase by close to 27 percent and those with diabetes estimated to grow 21 percent from 2013 to 2025, the report said.
The management of the growing burden of chronic disease will require a large and diverse multidisciplinary healthcare workforce, including specialists, as part of evidence-based care plans, said the authors in the report. How many specialists and the mix of specialties is difficult to determine, though.
The supply for some specialties in some areas is already inadequate. For example, the average wait time in 2012 to see a neurologist was 34.8 business days for a new patient visit and 30 days for a follow-up visit, the authors noted.
“Failure to train sufficient numbers of specialists could exacerbate already long wait times, reduce access to care for some of the nation’s most vulnerable patients, and reduce patients’ quality of life,” the authors said in the report.
The Health Affairs study shouldn’t cause a rush to buttress specialties, said Reid Blackwelder, MD, president of the American Academy of Family Physicians (AAFP), said in response the study’s results. “We can’t be backing off the needs of primary care,” Blackwelder said. The AAFP has long argued for more reimbursement for and support of primary care.
The assumptions in the article are based on the current healthcare system, he said, which does not emphasize primary care and is, for the most part, reactive.
“We’re used to taking care of people once they have developed these complications,” he said. “The whole point of getting primary care as the foundation to the healthcare system is to try to change the disease burden.”
A potential solution to effectively managing the aging population with its multiple chronic diseases and the forecasted deficit of primary care physicians and specialists is to use the team-based approach to care management, a model AAFP has been advocating for years.
At its core, team-based care is based on primary care and care coordination to manage diseases. Furthermore, Blackwelder noted, in such a model, non-physician team members can perform many of the aspects of the family physician or specialist. “A lot of my patients, when they see their cardiologist, often are seen first by a nurse practitioner,” Blackwelder said.
The American Board of Medical Specialties did not respond to requests for comment for this story.