Vol. 24 Annals of Health Law 316
Some researchers predict a shortage of 35,000-44,000 primary care physicians by 2025.294 The Association of American Medical Colleages predicts a far more dire scenario: a shortage of approximately 45,000 primary
care physicians by 2020, increasing to approximately 66,000 by 2025.295
As these projections persist, and as a surge of newly insured patients
continue to enroll with implementation of the ACA, discussions and debates
continue over how to ensure that patients have adequate access to care. 296
The ACA addressed this by promoting patient-focused, access to team-based care through encouraging the development of new models of care, including Patient Centered Medical Homes (“PCMH”) and Accountable Care
Organizations (“ACOs”). 297 These models set the stage for increased
breadth and effectiveness of care coordination in the United States, and PAs
293. Karin Rush-Monroe, UCSF Researchers Offer Solutions To Looming Health Care
Provider Shortage, UCSF NEWS (Nov. 5, 2013), available at http://www.ucsf.
shortage# (“The United States faces a severe shortage of primary health care providers, due
to a wave of aging baby boomers, epidemics of diabetes and obesity and the Affordable Care
Act, which aims to bring health care coverage to millions more Americans.”).
294. Jack M. Colwill et al., Will Generalist Physician Supply Meet Demands of an Increasing and Aging Population? 27 HEALTH AFF. 232, 236 (2008).
295. The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated
Projections Through 2025, ASS’N OF AM. MED. COLL., available at
visited October 2, 2014). See also, Physician Shortages to Worsen Without Increases in Residency Training, ASS’N OF AM. MED. COLL., available at https://www.aamc.org
pdf (last visited Nov. 11, 2014) (further predicting greater shortages due to funding constraints on postgraduate training for residents and fellows).
296. News Release, Coalition for Patients’ Rights, Meeting Primary Care Needs of Patients Drives Debate, Discussion on Workforce Shortage (March 27, 2013), available at
297. See Valerie Blake, Scope of Practice in Team-Based Care: Virginia and Nationwide, 15 VIRTUAL MENTOR AM. MED. ASS’N. J. OF ETHICS, 518, 518 -521 (2013) In order to
control health care costs and increase care coordination, proposals to reform U.S. health care
delivery and payment emphasize team-based models of care. Accountable care organizations
(ACOs) under the Affordable Care Act of 2012 (ACA) are one such example. In that model,
groups of physicians, hospitals, and other providers join together to provide cost-conscious,
quality, coordinated care to patients.; See also Karen Davis et al., How the Affordable Care
Act Will Strengthen the Nation’s Primary Care Foundation, 26 J. GEN. INTERN MED, 1201,
1202 (2011) The ACA also incentivizes the adoption of another model of care: the patient
centered medical home. This is accomplished through increased reimbursement to primary
care sites designated as “health homes” for Medicaid patients with chronic conditions. While
health homes are similar to medical homes, they place more emphasis on public health integration and the potential lead role of advanced practice nurses. Under the ACA, teams of
primary care providers—physicians, PAs, and nurse practitioners—provide comprehensive
care management, care coordination health promotion, transitional care between hospital and
primary care, referral to community and social services, patient and family engagement and
use of information technology to link services.