In the U.S., less than one-quarter of new doctors choose primary care as their field of practice and less than five percent set up their practice in rural areas.  This continues an alarming trend of primary care shortage in America.

The New England Journal of Medicine raised concerns about the future of primary care in 2006.  Issues were raised regarding both the quantity of primary care providers and the quality of care that is provided.  In particular, primary care faces growing demands related to the referral process required by most insurers before a patient may see a specialist.  Moreover, the prevalence of chronic diseases is increasing.  These ongoing conditions are usually managed in a primary care setting, increasing the burden for this sector of providers.

One of the common recommendations for addressing the primary care shortage centers on the use of educational incentives.  The Institute of Medicine supported federal funding for graduate medical education in order to target the needs of primary care settings.

A study in the journal Academic Medicine considers a new program for federally funded education that was created through health reform in 2010.  The program provides funding to community-based health centers that expand or create primary care residency programs.  The researchers examined the 11 initial centers that were included in this program and found that the integration of education related to rural areas showed promise for addressing the shortage in these underserved populations.

Providers, patient groups, and consumer organizations continue to be concerned about the future of primary care inside and outside of rural settings.  Congressional testimony on the future of primary care highlighted these concerns, contending that there are disincentives to training and entering the primary care field.  Moreover, utilization of primary care has the ability to improve health outcomes and reduce wasteful care, such as through unnecessary emergency department visits.

Others think that the solution comes not just from changes in education and financing of healthcare, but also through the use of existing provider options.  For example, according to the AARP Blog, nurse practitioners are given sufficient education and training to fill the gap in primary care.  Unfortunately, there are federal and state legal restrictions on the extent of their practice.  Some groups have urged that these laws be relaxed so that providers such as nurse practitioners and physicians’ assistants may help meet the critical need.  On the other side of the argument, many physicians do not support the use of nurses without a doctor’s supervision.  If these types of providers are not used, other action is needed imminently to improve the outlook of primary care.