A recent report from the Missouri Hospital Association shows a growing divide in the supply and demand gap for primary care providers in the state.
The report suggests a shortage of providers will affect the health care system’s capacity to deliver services in a few years, particularly in rural communities, unless steps are taken.
Primary care, which is normally a patient’s first point of entry into the health care system, can include health promotion, disease prevention, health maintenance, counseling, patient education and diagnosis, and treatment of acute or chronic illnesses, according to the American Academy of Family Physicians.
It can occur in a number of health care settings, including but not limited to medical offices, inpatient facilities, critical care facilities, home care and others.
Primary care can be described as the gateway to health care, according to the Primary Care Physicians Missouri Workforce Update 2018.
The report last was done in 2014. Since then, the number of physicians throughout the state has increased, including in rural communities, but shortages remain and continue to worsen, according to the report.
It cites studies showing, as demand grows, Missouri could have a shortage of up to 49,300 primary care physicians by 2030.
For the first time in the nation’s history, the U.S. Census projects people 65 and older will outnumber people under 18 by 2030.
At that time, more than a fifth of the population is expected to be 65 or older, including all baby boomers. These factors will continue to increase demand for primary care physicians.
The state’s medical schools are churning out enough physicians to keep up with demand, but Missouri is unable to retain many of its graduates.
Only 21.5 percent of medical school graduates receive in-state residency, mostly because residencies haven’t kept pace with growth in medical school enrollment — 10 percent growth from 2006-16. Research shows 68 percent of physicians who complete all of their training in Missouri — including residency — end up practicing in the state, according to the report.
Adding to concerns is the health of the state. Missouri’s health rankings continue to slip, according to the MHA. The state was 37th-ranked in 2014 and 40th in 2016, the report notes. Additionally, it ranks 42nd in senior health and 35th for women and children.
“Increasing the number of primary care clinicians is important, so is the location of the clinician’s practice,” the report says. “The distribution of physicians can result in large primary care ‘deserts’ in areas of rural Missouri, as well as under-served areas of urban Missouri.”
According to the Missouri Department of Health and Senior Services, 99 of 101 rural counties are considered Primary Medical Care Health Professional Shortage Areas, meaning they have shortages of primary medical care and dental or mental health providers. They may have too few primary care providers, high infant mortality, high poverty and/or a large elderly population.
Missouri’s rural counties make up about 38 percent of the state’s population. Rural counties tend to be heavily composed of elderly residents. The Missouri State Plan on Aging 2015-2019 forecasts those with chronic diseases will increase and the need to access health care services and primary care will increase “substantially.”
“Attracting physicians to Missouri and retaining physicians who attend medical school and residency in Missouri will mitigate some of the primary care workforce challenges,” MHA President and CEO Herb Kuhn said in a news release. “In addition, increasing the number and scope of practice and non-physician clinicians, including nurse practitioners and physician assistants who support delivery of primary care, could further reduce the caregiver supply and demand gap.”
His organization said the state has made several steps to alleviate the primary care physician shortage, including passing legislation authorizing community paramedics, improving access to telehealth services and authorizing more expansive distances in which advanced practice registered nurses may practice in rural communities.
House Bill 1617, sponsored by state Rep. Jay Barnes, R-Jefferson City, was signed into law June 1. It expanded use of telehealth services for Medicaid patients and removed restrictions to the use of the services.
Missouri’s physician-centered recruitment and retention programs, such as the Primary Care Resource Initiative for Missouri, which assists with forgivable loans for physicians who practice in rural or under-served communities, are also important to improving health care in rural communities, according to the MHA.
“Missouri is making important progress in addressing the state’s physician shortage,” Kuhn said. “However, without significant investment and policy changes, the growth in demand for health care services will continue to outstrip the supply of primary care professionals.”