Family Physician Shortage

Address the Family Physician Shortage

As more family physicians reach retirement age, the U.S. is facing shortages of 18,000–48,000 primary care physicians by 2034.[i] More needs to be done to address this shortage and increase the number of residents choosing family medicine. Significantly higher reimbursement for specialists relative to primary care physicians contributes to the current imbalance between primary and specialty care.

 In addition, primary care physicians are poorly compensated relative to their peers in specialty services. In 2017, the median compensation for physicians in radiology, procedural, and surgical specialties had an almost twofold difference compared to primary care physicians. This compensation gap is associated with the reduction in medical students choosing primary care careers and the shift of hospital graduate medical education (GME) priorities away from primary care.[ii]

 A recent study of compensation trends for primary care and specialist physicians after the implementation of the Affordable Care Act found that from 2008 to 2017, specialist compensation increased by a weighted mean of 0.6 percent (1.2 percent) per year, from $378,600 to $399,300, whereas primary care compensation increased by a weighted mean of 1.6 percent (2.2 percent) per year, from $214,100 to $247,300. Although there was a larger increase in compensation for primary care physicians during this time, the gap between specialty and primary care salaries remains sizable. Physician compensation—specifically, the differences in compensation between primary care physicians and specialists—remains a concern that policymakers must address to incentivize physicians to pursue primary care.[iii]

 Also, ACOFP is concerned about the use of non-compete clauses in employment contracts for physicians. These clauses limit or prevent the ability of employees to join or start a competing firm after separating from their jobs. As a result, physicians subject to a non-compete clause must either move geographic locations or stop practicing medicine, which only serves to exacerbate the family physician shortage. ACOFP supports ongoing efforts among federal and state policymakers to ban the use of non-compete clauses.

 Moreover, medical students are financially incentivized to choose specialty training such as cardiology or pulmonary medicine, over primary care because of higher reimbursement for certain specialty medicine services, such as high-cost imaging, testing, and procedures.[iv] Recent efforts to increase Medicare reimbursement, including through the calendar year (CY) 2020 Medicare Physician Fee Schedule (PFS) final rule, have been positive steps toward payment equalization. However, a significant reimbursement differential still exists between primary care and specialty care, which neither reflects the inherent complexity of providing evaluation and management services nor the significant value these services provide to patients and to the Medicare program overall. Incentives for medical students to choose family medicine include: 

• Equalizing reimbursement between various settings of care, i.e., office, outpatient clinic, emergency department, and between family medicine and specialty medical services;
• Enhancing reimbursement by rewarding care that is proven to ensure high-quality patient outcomes and patient satisfaction; and,
• Providing financial support in the form of loans, loan forgiveness, and loan deferment.

In addition, more training opportunities are needed for medical students choosing family medicine, and medical education funding programs must be preserved and expanded, including Medicare GME, Teaching Health Center GME (THCGME), and Title VII.

Advocacy Positions:

• Support policies that equalize reimbursement for primary care and specialty care.
• Through reimbursement policies, reward care provided by family medicine that is proven to ensure high-quality patient outcomes and patient satisfaction.
• Expand access to loans for medical students and support deferment and forgiveness of loans for medical students who commit to specializing in primary care.
• Increase financial support to hospitals, especially those in rural areas, to establish residency programs in family medicine.
• Protect and expand medical education funding, including Medicare Direct and Indirect GME funding, and preserve existing alternative GME programs, such as the THCGME program and Title VII.
• Support policies that equalize compensation for primary care and specialty care.
• Support efforts to ban the use of non-compete clauses for physician employment contracts.

[i]The Complexities of Physician Supply and Demand: Projections from 2019 to 2034.Association of American Medical Colleges. June 2021. Accessed January 12, 2023. https://www.aamc.org/media/54681/download

[ii] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care. Robinson SK, Meisnere M, Phillips RL Jr, McCauley L, eds. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. National Academies Press; 2021. doi:10.17226/25983

[iii] Hsiang WR, Gross CP, Maroongroge S, Forman HP. Trends in compensation for primary care and specialist physicians after implementation of the Affordable Care Act. JAMA Netw Open. 2020;3(7):e2011981. doi:10.1001/jamanetworkopen.2020.11981

[iv] Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. doi:10.6064/2012/432892