Primary Care Cliff: Case Study

Given that there is a shortage of physicians nationwide it is important to expand the scope of mid-level practitioners such as nurse practitioners and physician’s assistant, who are pivotal in treating the mass influx of patients, especially in underserved areas. Rural communities tend to be poorer, and unable to afford to hire enough physicians, and many rural Americans are less well insured, driving the cost of treatment up (RHF, 2015). The lack of resources and funding in underserved areas means even less incentive for physicians to practice in rural areas. Mid-level practitioners are trained to treat patients with low-level illnesses, provide care to patients with chronic and acute diseases, as well as refer patients with more complex issues

A Community health center can be defined as a center where high quality primary and preventive healthcare is provided regardless of the ability of the patient’s financial situation. There are some basic characteristics a community health center must possess to be fully functional. Some of which are:

Department of Health & Human Services, 2015). These provisions were aimed at providing new protections for health insurance consumers, lowering the cost and improving the quality of health care, and increasing access to health insurance and affordable care. While many of the ACA’s provisions had implications for community health centers, the ones that impacted them most directly were the expansion of Medicaid and availability of subsidized health insurance through exchanges and the creation of the Community Health Center Fund, which allocated $11 billion in new funding through fiscal year 2015 for operations, capital projects, and expansion of services to enable community health centers to serve an anticipated 20 million newly insured patients (National Association of Community Health Centers, n.d.; “Valley Community Healthcare,” 2015).

Currently, there is still a large shortage of primary care practitioners in the United States. The margin between available providers and those in need continues to grow. Many people without proper access to care have to delay seeking help for what ails them ("Health Wanted," 2012). Glicken & Miller (2013) state that approximately 16,000 primary care providers would be necessary to meet the existing demand. Rural communities would represent the area of greatest need followed closely by low-income urban areas. The number of underserved individuals is estimated to have reached fifty-seven million. This demand will only increase, as 52,000 primary care providers are expected to be needed by the year 2025 (Glicken & Miller, 2013, p.1883-1889).

The new federal health-care law has raised the stakes for hospitals and schools already struggling to train more doctors. Evidence suggests there won’t be enough number of doctors to treat the newly insured millions under the ACA. At current graduation and training rates, America faces a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The greatest demand will be for primary-care physicians. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more with longer wait times under the new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER

“By expanding loan benefits and increasing residency programs, Open Door Community Health Centers will be able to attract a highly qualified pool of candidates to our area creating more access for healthcare, a diverse clinical experience, and incentivize providers to remain on the rural North Coast and become active community members.”

Overall, the primary issue is clear. Detroit cannot meet the demand for care (especially primary care). They are overwhelmed by the influx of uninsured and poor in all hospital systems and departments (ER in particular [mental patients overwhelmingly]). The Health Authority and VODI work, which consolidates the safety net financing and health care delivery for the poor, is a great start in dealing with the presented problems. The recommendation for stakeholders needing to attract primary care physicians to the area is an obvious must, but we need incentives. Formulating group partnerships and teaming with other states could infuse money into the Detroit health care system. The assessment could have provided a better case with key documented interviews; such as the testimonies of doctors and volunteers that work at the “free” clinics, and how “overwhelmed” they are by the huge increase in the uninsured. Also, there should be more evidence, backed with statistics that demonstrate primary care physicians are scarce.

Similar to my home state of Louisiana, Tennessee has also struggled with a chronic shortage of rural primary care physicians. While this statistic does depict a true challenge for our two states, over the years Meharry Medical College has done an exceptional job in inspiring medical students to one-day practice in a rural setting and bring about better health care to underserved individuals, regardless of race or ethnicity. This aspect

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

This program will help to bring healthcare education services closer to the people in my community. Personally, I encountered many challenges in my childhood due to poor health care services in the community. The idea of having access to a good healthcare provider was unheard of in the Latino circle because they were unreachable and expensive. Secondly, affordability of the healthcare due to high costs of having health insurance was also popular among the Latino community. For those who could access medical facilities, the challenge was related to the health insurances did not cover all their needs. These challenges were too pronounced. They influence my desire to enroll in this program because I seek to change the situation back at home. Through

Americans will have insurance coverage. The US has an unequal distribution of the primary care, thus; the rural areas have been left with only few physicians. Many physicians prefer practicing in urban areas because of the lucrative advantage, better technology or demographic preference. Many sources including Green et al, of Anita Phigpen Perry School of nursing confirms that the reason for the shortage of physicians in the rural areas is due to the tendency of people in the rural areas being poorer, sicker and older . This segment of people tends to be uninsured, and physicians are attracted to urban and suburb areas where revenues are. Today with the ACA policies, people in the underserved area have better access to physicians, although the shortage persists. The US Department of Health and Human Services, states that to help strengthen access to the primary care workforce, the Affordable Care Act invests in health work force training, including: a $ 1.5 billion investment in National Health Service Corps Scholarship and loan repayment programs and $ 230 million over five years to primarily train medical residents in community-bases. However, do we have enough experts?

The underserved populations have increased exponentially. The Rural Policy Research Institute (2009) defines the medically underserved as, “the ratio of primary care physicians per 1,000 population, the infant mortality rate, the percent of the population with incomes below the poverty level, and the percent of the population age 65 and over.” By that definition, over half the state is considered to be an underserved population. With the demand and needs of the state, it is no surprise that the FNP has become a more utilized provider of healthcare is many settings. There has also been a recent emergence of nurse-managed health centers or (NMHCs), as a form of primary care delivery. According to Espirat and Debisette (2012), NMHCs reduce Medicaid costs, are a great Segway to community outreach and provide quality primary prevention.

The health care system must change to improve our nation’s health and takes strong steps to address the unsustainable growth of health care costs in America. We still have a long way to go before our health system become effective. We still have population that do not have insurance, have difficulties accessing their health care, or their needs are not met within the healthcare system. It is an investment in prevention and wellness and increasing access to primary care physician.

The Affordable Care Act set forth millions of dollars to address the problems and concerns that are associated with existing physicians shortages. The Affordable Care Act also has provisions that are aimed to improve the education, ongoing training as well as to help with the recruitment of nursing, physicians, doctors as well as other health care personnel. In addition, there are provisions in place that help to increase workforces’ cultural competency, enhance faculty training of healthcare professionals, and diversity. The provisions also play a vital role because of the fact they are put into place to examine innovative reimbursement and care delivery models that highlight primary care services value and offer in improvement in the patient care coordination.

I would be honored to enroll at the WMU homer Stryker M.D School of Medicine because of the school’s dedication to educating physicians through community outreach and commitment to lifelong learning. After volunteering for the past five years at the C.A.R.E. Clinic for the uninsured, I understand the need to serve uninsured Americans. Therefore, I want my medical school experience to incorporate opportunities to serve this population at locations such as the Family Health Center. In addition, the community health rotation would allow me to continue my commitment to the under and uninsured