The supply and demand gap for primary care providers of health care in Missouri will challenge the health care system’s capacity to deliver services in the coming decades.
The supply and demand gap for primary care providers of health care in Missouri will challenge the health care system’s capacity to deliver services in the coming decades. Although more than 600 additional primary care physicians are practicing in Missouri since the last report on the physician workforce was published in 2014, the rate of growth is insufficient to address the anticipated needs of the aging population.
Primary care is the gateway to health care. Improving individual, community and population health requires access to primary care. However, Missouri’s health rankings continue to decline — from 37th to 40th nationally — and the state ranks 42nd for senior health and 35th for women and children.
“When Missourians have access to, and regular contact with, primary care providers, they are able to manage health conditions, avoid illness and improve outcomes,” said Herb B. Kuhn, MHA President and CEO. “Barriers to primary care can result in poor health outcomes and higher costs for individuals and the health care system. This includes issues in the physician education system that restrict the number of providers that practice in the state. One of the key issues constricting the pipeline is the lesser number of residency slots than graduates from the state’s medical schools.”
Missouri’s medical schools train more physicians than the state is able to retain. Only 21.5 percent of medical school graduates receive in-state residency, because the growth in residency slots has not kept pace with the 10 percent increase in medical school enrollment that occurred between 2006 and 2016. Research suggests that 68 percent of physicians who complete all of their training in a state end up practicing in that state.
Missouri also falls within a favorable physician compensation region, creating an additional reason for physicians to stay or locate a practice in the state. Missouri has benefited from an influx of physicians since 2014. The increase among rural counties is especially encouraging. Nonetheless, demographic and socioeconomic factors are driving demand for health care services at a rate that exceeds even the growing supply. To address Missouri’s poor health status, additional primary care providers will be required. The demand for primary care services will continue to increase as the population ages. By 2030, one-fifth of Missourians are projected to be age 65 or older — an increase of 87 percent over three decades. Older Missourians are overrepresented in the rural population.
“Attracting physicians to Missouri, and retaining physicians who attend medical school and residency in Missouri, will mitigate some of the primary care workforce challenges,” Kuhn said. “In addition, increasing the number and scope of practice of nonphysician clinicians, including nurse practitioners and physician assistants who support delivery of primary care, could further reduce the caregiver supply and demand gap.”
Missouri has made several promising steps to alleviate the primary care physician shortage. These include legislation authorizing community paramedics, assistant physician authorization and improvements in access to telehealth services. Earlier this year, Missouri authorized more expansive distance requirements for APRN and physician collaboration, extending the APRN services to additional rural communities.
Physician-centered recruitment and retention programs in Missouri are important, as well. Hospitals have invested $12 million in the state’s Primary Care Resource Initiative for Missouri since 1993. PRIMO assists with forgivable loans for physicians who practice in rural or underserved communities. The University of Missouri-Columbia School of Medicine Rural Track Pipeline Program is designed to address rural primary physician shortages in the state.
“Missouri is making important progress in addressing the state’s physician shortage,” Kuhn said. “However, without significant investment and policy changes, the growth in demand for health care services will continue to outstrip the supply of primary care professionals.”