By any reliable estimate, Delaware is in a primary care crisis. It’s only going to grow worse as the health care workforce ages, retires, or modifies its practices, reimbursements stagnate or shrink, and the population continues to age.
A sampling of the predictions:
The Association of American Medical Colleges projects a shortage of 91,500 physicians by 2020
The Council on Graduate Medical Education projects a physician shortage of 85,000 by 2020
The Robert Graham Center predicts that, just to maintain the status quo in 2030, Delaware will need a 27 percent increase in primary care physicians (PCP) over its 2010 level
Even maintaining the status quo isn’t a great position to be in. The Delaware Health Care Commission reported an estimated 863 primary care physicians practice in the state, which translates to a ratio of 1,187 residents per one PCP. However, the Health Care Commission reported also that all of Kent and Sussex counties and portions of New Castle County are federally designated shortage areas for primary care, meaning they meet or exceed the federal definition of 3,500 residents per physician. That places Delaware far beyond the 1,250 residents to one PCP measure that is considered to be at the very low end of acceptable.
Delaware finds itself in this situation for multiple reasons. Many medical school graduates gravitate to higher-paying specialties and avoid primary care. Other studies have found that women tend to become primary care physicians at a higher rate than men, but they also tend to work fewer hours. As is the case across the country, many independent physician practices are being folded into hospital systems. The independents also have reported problems attracting new physicians and covering their own bills because of low reimbursement rates.
In fact, the president of the Medical Society of Delaware reported that, nationally, commercial insurers pay primary care practitioners 20 to 30 percent above Medicare rates. In Delaware, primary care physicians testified in a legislative hearing last spring that commercial insurers pay independent primary care physcians 15 to 35 percent below Medicare rates.
Further, insurance plans around the country make 6 to 8 percent of their total medical expenditures on primary care. In Delaware, it’s an average of 3 to 4 percent, according to reporting by Delaware Online.
The facts continue to snowball. The Delaware Health Care Commission report also notes that nearly 40 percent of Delaware physicians are over 55 and a third could retire in the next 10 years. Adding to the shortage, other physicians have decided to move to concierge medicine. They drastically reduce their patient load in return for a smaller clientele that pays a yearly fee for guaranteed service. Concierge doctors generally don’t accept insurance.
As if that isn’t enough, Delaware’s population continues to grow and age. The U.S. Census Bureau expects the state’s population to increase nearly 30 percent by the year 2030, while the number of residents over 60 will skyrocket 43 percent in the same time frame. Analysts attribute some of the increase to baby boomers aging in place and some to seniors retiring in Delaware to enjoy its low taxes, seasonal amenities, and proximity to major cities.
Pressure is mounting. The Robert Graham Center recommends Delaware policymakers consider strategies including reimbursement reform, increased funding for primary care training, and medical school debt relief. The Governor recently signed legislation, SB 227, to guarantee PCPs a minimum reimbursement level no lower than Medicare reimbursement for primary care office visits, but the legislation sunsets (expires) after three years.
Studies have shown communities with access to primary care stay healthier and save the health care system money in the long run. Delawareans shouldn’t have to head to neighboring states to seek basic health care.