Preserve the Family Medicine Model of Care

Preserve the Family Medicine Model of Care

Family medicine plays a critical role in the provision of primary care, contributing to improved patient outcomes and reduced healthcare costs. ACOFP is concerned about federal policies that incentivize replacing family physician services with those of nonphysician practitioners, such as nurse practitioners and physician assistants. For example, a study found that from 2013 to 2019, the proportion of all visits delivered by nurse practitioners and physician assistants in one year increased from 14 percent to 25.6 percent.[i]

Physician-led care teams are the gold standard for care delivery, and nonphysician-led care teams are not equivalent because they do not have the same training or education. A family physician will spend an additional 18,900 hours on education and training compared to mid-level practitioners.[ii] Decades of evidence have shown that physicians are better positioned to deliver high-quality care because of their demanding education and professional training requirements. As a result, beneficiaries experience better health outcomes and Medicare realizes overall savings from healthier seniors.[iii][iv][v] While the use of nonphysician practitioners may be appropriate under certain circumstances and with adequate physician supervision, the nonphysician practitioner model is not an equivalent substitute to the use of family physicians. Also, when a patient receives healthcare services from a nonphysician practitioner, it should be made clear to the patient that the practitioner is not a physician.

Furthermore, the number of small and solo family medicine private practices has declined in recent years. More and more of these practices are being acquired by larger practices, private equity, and hospitals because of their inability to compete financially with these organizations.  Other practices are closing altogether. ACOFP believes it is essential that policymakers support private practices—especially small and solo family medicine practices in rural and underserved areas—which can tailor how they provide care to best meet the needs of the communities they serve and remain a critical access point for primary care. In many areas, family physicians are the primary source of care, and even before the COVID-19 pandemic, small, independent, and solo practices faced barriers, including physician shortages, low reimbursement, and overly burdensome regulations. It is critical that Congress and the federal government support family medicine; otherwise, patients across the country will lose access to care.

 ACOFP also believes that Congress and the Biden administration should support opportunities for medical students to train in private practices and should continue to support innovative payment models, like direct primary care (DPC) arrangements. Finally, ACOFP encourages policymakers to consider the clinical value and benefit to patients of osteopathic manipulative treatment (OMT). OMT is an important, but underutilized, tool that should be supported through appropriate reimbursement policies.

Advocacy Positions:

• Support policies, including reimbursement policies, that do not create incentives to use nonphysician practitioners in lieu of family physicians.
• Deliver the highest quality care for patients through physician-led teams.
• Establish physician supervision and scope-of-practice requirements through state medical regulatory entities.
• Provide small and solo family medicine private practices with direct access to federal resources, as well as administrative flexibility.
• Ensure access to OMT as a high-value treatment for patients.
• Continue to support DPC arrangements through appropriate tax treatment (e.g., allowing DPC models to be paid through health savings accounts).
• Support transparency requirements that ensure patients know when they are receiving care from nonphysician practitioners instead of physicians.

[i] National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information. Provision of evaluation and management visits by nurse practitioners and physician assistants in the USA from 2013 to 2019: cross-sectional time series study. Published September 14, 2023. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498453/

[ii] Primary Care Coalition. Compare the education gaps between primary care physicians and nurse practitioners. Texas Academy of Family Physicians website. Accessed January 20, 2023.https://tafp.org/Media/Default/Downloads/advocacy/scope-education.pdf

[iii] Lohr RH, West CP, Beliveau M, et al. Comparison of the quality of patient referrals from physicians, physician assistants, and nurse practitioners. Mayo Clin Proc. 2013;88(11):1266–1271. doi:10.1016/j.mayocp.2013.08.013

[iv] Hughes DR, Jiang M, Duszak R Jr. A comparison of diagnostic imaging ordering patterns between advanced practice clinicians and primary care physicians following office-based evaluation and management visits. JAMA Intern Med. 2015;175(1):101–107. doi:10.1001/jamainternmed.2014.6349

[v] Muench U, Perloff J, Thomas CP, Buerhaus PI. Prescribing practices by nurse practitioners and primary care physicians: a descriptive analysis of Medicare beneficiaries. Journal of Nursing Regulation. 2017;8(1):21–30. doi:10.1016/S2155-8256(17)30071-6