In the US, there is a gap in the primary care medicine sector. This means that there are more patients than there are providers, and it is causing a backlog of patients. If you’ve tried to make a primary care or family medicine doctor’s appointment recently, you may have found yourself looking at a wait of a month or longer.
This can be frustrating, especially when you are sick and want or need to be seen sooner. This can leave you waiting in an urgent care office for your turn to be seen, filling out your medical history over and over and hoping that you don’t forget anything. This is the pain that many Americans are feeling now.
The National Library of Medicine states: “Over 57 million individuals live in 5,864 designated primary care shortage areas in the United States. By definition, individuals in these urban and rural communities face a deficit of primary care providers in four primary care specialties: general or family practice, general internal medicine, pediatrics, and obstetrics and gynecology.”
This adds another layer to an already complex problem with disproportionate effects on minority communities. With a lack of access to care extending into more vulnerable communities with increasing frequency, this leaves more opportunity for improvement.
The potential for worsening conditions is real and expanding. The lack of providers can be attributed to many factors, including the cost of education and training. It is expensive to go to school for several years to become a physician, and it leaves the student with considerable debt in a field that doesn’t pay as much as other specialty fields.
Time magazine reported in July 2022 that: “For Frankel, the issue boils down to ‘an increased demand and relatively fixed supply in the physician labor market. Training new physicians is a time-consuming and expensive process, and there are only so many medical schools in the U.S., with so many seats,’ and which have not kept up with the demand for physicians.”
Practical training and internships or residencies can last years after school is completed and require full-time hours while the student is unable to work another job due to the time demands. This demand on time can also lead to high stress from the environment and the external factors such as income and relationships that may suffer.
The number of students who join these programs is relatively the same year after year, but the demand has increased. The population has shifted, with an increase in older patients tipping the scales from pediatric patients. These patients prefer to see one main physician for their care, and that physician handles any non-specialty long-term care and support.
There is also the health of older generations, with many having health issues that require long-term care. This care can mean several regular appointments with their primary physician, and these appointments take up slots for any acute care needs from other patients or themselves.
Another contributing factor is the expansion of access to health insurance. With all the changes in that sector in the last decade, many more people have health insurance than ever did before. This means that more people can afford to go to the doctor, if they can get in.
There is also little incentive for students to go into the primary care sector, and without that, the number of students is unlikely to change. With the population shift as it is, the demand will likely remain higher than the number of physicians available for many years.
Solutions
Now, more than ever, changes are needed to provide all generations with access to primary care when they need it. There are several ways that have been proposed to close the primary care gap. Some of these proposed solutions are:
• Debt relief for student loans.
• Increased access to technology.
• Funding increases.
• Reducing the salary gap between specialties.
• Nurse practitioners.
The first is debt relief for student loans. Without a large amount of debt to pay back, more students may be incentivized to go into primary care. There is no guarantee for this, and the question remains as to how that debt relief would work and who would pay for it.
The concept of student loan debt relief is not new, but there are many problems with this solution. Students currently applying for debt relief for other things have to jump through hoops and have a hard time being approved. This could counteract the benefit for some people and not improve the gap overall.
Increased use and access to technology could help to close the gap. Virtual visits could be used for some appointments, reducing the amount of time needed for the appointment and allowing patients to see doctors from anywhere. This could be used for routine follow-ups or acute care appointments that do not need a physical exam.
The drawback to this option is that the primary care physician still only has so many available slots, and not every type of appointment would meet the criteria for being virtual. Some appointments will still require a physical exam of the patient and this can only be done in person. It may reduce some of the wait time for patients but would not solve the problem overall.
The increased access to technology could reduce the amount of time spent on paperwork and documentation of visits. Many in primary care are now able to document an appointment in real time at a computer in the room. This saves time that would normally be needed to complete documentation between appointments or at the end of the day.
There are also electronic health records, which save patients from having to give their entire health history each time they get a new doctor. This information allows the primary care provider to review notes before seeing the patient, or at the same time, and less time needs to be spent on the appointment.
Overall, technology would improve but not solve the primary care gap in the US. Some of these methods are already in use, and there is still a large gap to be filled.
Funding increases in large health systems may provide an incentive for more internship and residency opportunities. This would allow more students to train as primary care doctors and would be able to assist with patients to help close the gap while they train. It could be a twofold improvement in solving the problem while training.
Closing the salary gap between specialties and primary care would go a long way toward solving the primary care gap. The significantly reduced pay for primary care compared to specialties helps drive the lack of primary care physicians.
With high debt from school, many students choose a high-paying specialty. If this gap were closed, it would assist with more providers. There is the concern of how that gap would be closed as private practices would not be bound by this unless new legislation was passed, and it would likely create a large upheaval in the medical community. There is also the risk that this would not help close the gap and not many students would choose the primary care option as their specialty.
Yet another solution, and largely one of the most attainable, is to employ more nurse practitioners in family care. Nurse practitioners can see patients, in most states, and make the same decisions as a doctor, but the path to becoming a nurse practitioner is decidedly simpler.
Nurse practitioners can often do most of their coursework online prior to (or alongside in some cases) clinical placements. While there are some restrictions or limits to what a nurse practitioner can do, such as needing sign-off on care plans by a physician, the access to care for patients would increase.
There may be no magic solution to solve the primary care gap with one change, but a combination of several approaches would go a long way to closing it. More registered nurses (RNs) expanding their skillset to becoming family nurse practitioners (FNPs) would be the biggest improvement.
Family nurse practitioners
There are nearly three million RNs in the US, and it is the number-one employed role in healthcare. This means that there are 3 million nurses that could become an FNP in just a few years.
Increased education is still required, but it is fewer years than a family care physician. Due to the reduced education requirements, there are restrictions on what an FNP can do unsupervised.
In addition, pay is higher for a nurse practitioner. This alone could provide incentives for nurses to move into this new role. That incentive is provided without additional funding and is a natural salary increase for a new specialized role.
Nurses are also often in the role of taking down notes for physicians, making them already experienced in this area and the technology that is widely used now. The nurse would also already have experience with patients, something that many physicians do not have until they begin their internships and residencies.
In addition to the salary incentive is the increased access to education. Many RNs can begin their journey to becoming a FNP online. This flexibility means that there would be no lack of support while they return to school, and financially this would mean the potential for significantly less debt.
According to Carson-Newman Online, a “2020 survey by the American Association of Nurse Practitioners (AANP) shows how nurse practitioners are well-positioned for primary care roles. Eighty-seven percent of respondents specialized in primary care fields including 65.3% in family practice. This trend means nurse practitioners are prepared to serve underserved communities.”
Another possible incentive to healthcare facilities is the reduced cost of FNPs. While an FNP earns more than an RN, they earn less than a physician, which can help lower-income communities afford more access to family care providers with funding support already in place.
Nurse practitioners in underserved areas provide the largest value to those communities while still providing a similar level of patient care. This improvement would impact the most amount of people with a lack of access to care. If you are interested in becoming an FNP and helping underserved communities, Carson-Newman offers an MSN-FNP program with completely online coursework.
Yet another benefit for RNs would be career growth. There is less growth in the RN job market than in FNP, and it can be a way for a nursing professional to progress their career outside of moving into a leadership role and out of patient care.
The job outlook for RNs is expected to grow at an average pace of 6%, while the job outlook for a nurse practitioner is expected to grow 40% over the next decade, which is faster than average, according to the US Bureau of Labor Statistics.
The massive job growth as a nurse practitioner, especially an FNP, means that there are many positions available for you to step into after you complete all the requirements. The primary care gap being so widespread also means that the jobs are everywhere, and you could choose to work from the same location or move. You would not be limited as you could be in other fields by a lack of opportunities.
Treatment of patients would also be greater. There is an extremely broad range of ages that are seen by FNPs, and this can mean that you would get to treat multiple types of illnesses. This wide range also applies to treatments, as you would treat conditions that are typically treated by a general practitioner, from acute to chronic illnesses.
FNPs also make an impact on their patients and are often seeing a patient for their whole lives. Many people do not change their primary care provider outside of insurance changes and moves. This means that you can get to know your patients personally and make an impact on their lives through regular treatment and care.
Lastly, FNPs help to close the primary care gap. It can be rewarding to be a part of the solution while growing your career. Each new FNP makes an impact on the care gap and provides patients with an access to care that they did not have before or were in jeopardy of losing.
How to become a family nurse practitioner
The first step to becoming an FNP is to obtain your Bachelor of Science in Nursing (BSN) and pass the NCLEX to become an RN. From there, you can begin your journey to becoming FNP.
When you are ready to start your journey, it’s time to look at schools and find one that meets your needs. If you prefer to work and your schedule is not flexible, an online school might be right for you.
It is important to note that there will be clinical placement hours needed and required to pass the program. These may take time from your regular workday, so talk to your advisor and have a plan in place.
After completing your required coursework, you must sit for a board certification exam, similar to your NCLEX, and you must pass in order to be able to practice. There are two different certifying bodies – the American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) – so work with your school to find the best option for you.
Next, you are ready to find a position and begin practicing medicine. Depending on the state you choose to practice in, there are different levels of care that you can provide with or without supervision. However, your level of care would be higher than that of an RN.
Once you begin practicing, it is time to make an impact. You are already helping to close the primary care gap. Now, it is time to make positive impacts on your patients and build a relationship with them. You will get time to put all of your skills into action and treat a myriad of patients. Why wait? Start that journey now and help to close the gap in primary care in the US.