Michigan should invest in primary care doctors to ease a severe shortage of physicians that has led to long wait times, higher costs and missed care, a new report says.
A 14-point plan released Tuesday by the Michigan State Medical Society, calls for vastly expanding pay and reimbursements. Overall, 5% of total medical expenditures go to primary care. The society wants to boost that to 12%.
“Michigan has made an underinvestment in primary care,” said Dr. Tom George, an anesthesiologist and chief executive officer at the society.
Michigan is short at least 464 primary care providers, federal estimates show, fueled in part by a pay gap: They average $287,000 per year nationally, compared to $404,000 for specialists, according to one report last year.
Michigan’s population is aging faster than most states, with 1.9 million residents — nearly 1 in 5 — already 65 or older.
The health conditions that come with age further stress the health care system. George said his group wants to focus on primary care expenses as other expenditures grow.
“This is not ‘Let’s just pay the neurosurgeons less than we’ll pay primary care,’” George said. “We’re talking about the big pie of health care spending” as it grows.
The report, which calls primary care doctors “the foundation of a robust, effective, and efficient system,” stops short of dictating specific steps to spend more money on primary care.
But it highlights efforts elsewhere.
Oregon requires that 12% of the state’s Medicaid dollars be spent on primary care, while Rhode Island mandates commercial insurers invest at least 10% on primary care.
The report comes as more than 1 in 4 Michiganders, about 2.7 million, live in Health Professional Shortage Areas, a federal designation based on the number of providers, the portion of residents under the federal poverty level, and travel time to the nearest providers outside the designated area.
Legislators have considered solutions such as giving broader responsibilities to nurse practitioners — a step that some have argued could help expand access. The doctors’ group has fought that, saying that those clinicians don’t have adequate training and should not work on their own, but rather as part of a physician-led team.
Michigan is also weighing temporary licenses to doctors who earned their degrees outside the US or Canada and continued participation in an interstate compact that lets providers licensed in other states practice here.
Building teams
Raising insurance reimbursements to primary care doctors would have a ripple effect, said Dr. Dennis Ramus from his office this week in New Baltimore, north of Detroit.
The increased funds would allow them to add, at a minimum, a nurse case manager and an advanced practice clinician, such as a nurse practitioner or physician assistant, to their practices, he said. Ultimately those teams also could include pharmacists, social workers, psychologists and others, he added.
While some health problems require specialists, “I can generally take care of 65% of what you need done if you call me first,” said Ramus, the report’s lead author.
Moreover, Michigan retains less than half of the primary care physicians it trains, according to the report.
The Michigan State Medical Society report also recommended:
‘Foundational’ care
The new report echoes findings from the New York-based Milbank Memorial Fund, a nonprofit research organization that focuses on health equity and produces a dashboard that tracks primary care spending by state.
Milbank and the Michigan doctors group say boosting payments for primary care allows doctors to expand their practice, thereby offering better care to more patients.
The key is to have those team members on-site as familiar faces on the care team, Ramus said.
While many offices purport to have health care “teams,” members are often available only remotely, or they are a single staff assigned by a large health system to support many physicians, Ramus said.
“There’s this illusion of a team,” Ramus said.
While the reports’ focus is on primary care, the Michigan State Medical Society represents physicians of all specialties.
“Specialists recognize the value of a foundational primary care that serves as the triage, sending appropriate patients to them,” said George, the executive director.
Dr. Brad Uren, an emergency medicine doctor in Ann Arbor, said he often sees patients in the emergency room who need follow-up care but lack a primary care doctor for a myriad of reasons.
“It’s easy for me to say, ’Well, you’re not having a heart attack, but you need to follow up with your doctor because your blood pressure was high, and your sugar was high, and we know your cholesterol is not under good control,” he said.
But without a primary care home, that patient is likely not going to get critical follow-up care, resulting in a revolving door of emergency room visits, said Uren, who also is vice chair of the Michigan State Medical Society board of directors.
As a specialist or an emergency room doctor, Uren said, “you really need somebody to quarterback that care.”
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This story was originally published by Bridge Michigan and distributed through a partnership with The Associated Press.