The United States faces a looming shortage of primary care physicians. According to a 2014 survey by the Physicians Foundation, 81 percent of practicing physicians describe themselves as "overextended or at full capacity." To make matters worse, 44 percent of physicians are planning to "reduce patient access" to services — by going to part-time hours, for example. The shortfall is projected to be particularly acute in Florida.
A report released by the Robert Graham Center estimates that Florida will need an additional 4,671 primary care physicians — a 38 percent increase from the total in 2010 — to accommodate the growing demand for health care services. Why is Florida facing this problem?
As you might surmise, Florida has a higher percentage of elderly residents than most other states. According to the American Community Survey administered by the U.S. Census Bureau, Florida had the fifth-highest median age — 41.6 — among all states. This can contribute to higher physician demand.
Florida's certificate of need laws may also be contributing to restricted access to health care. Until recently, Florida was the only state in the nation that didn't permit nurse practitioners to prescribe controlled substances. Florida was also one of just two states, with Kentucky, that did not permit physician assistants to prescribe controlled substances. These policies have increased the cost of outpatient Medicaid services in Florida.
In my recent research for the Mercatus Center at George Mason University in Fairfax, Va., I find evidence that allowing physician assistants the authority to prescribe controlled substances is associated with an 11 percent reduction in the cost of outpatient Medicaid claims. Why would allowing physician assistants the authority to prescribe controlled substances reduce the cost of health care delivered to Medicaid patients? The data show that the reimbursement rate for physician assistants is lower than physicians in nearly half of all states. In Florida, it can be as low as 80 percent of the rate for physicians.
Although most Americans may prefer to see a primary care physician, preferences shift when they are forced to wait for care. Generally speaking, the average American would rather see a nurse practitioner or physician assistant as opposed to waiting to see a primary care physician. Unfortunately, it is difficult for nurse practitioners and physician assistants to serve as viable substitutes when they lack the authority to prescribe controlled substances.
The Florida Legislature took an important first step by moving closer to allowing nurse practitioners and physician assistants to prescribe controlled substances. Consideration should be given to broadening the prescriptive authority of each professional and eliminating additional barriers (for example, certificate of need laws).
It is not clear that nearly 5,000 new primary care physicians will enter the state of Florida between now and 2030 to meet the growing demand. Relative to other states, Florida makes it a bit easier for internationally trained physicians to practice in the state — foreign-trained physicians can practice after completing a two-year residence. More than half of U.S. states require a three-year residency. Yet Florida should not solely depend on recruiting foreign-trained physicians.
By granting nurse practitioners and physician assistants further autonomy, we can start addressing the projected shortfall of primary care physicians in Florida.
Edward J. Timmons is an associate professor of economics at Saint Francis University and author of a Mercatus Center at George Mason University working paper on "Healthcare License Turf Wars: The Effects of Expanded Nurse Practitioner and Physician Assistant Scope of Practice on Medicaid Patient Access." He wrote this exclusively for the Tampa Bay Times.