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Access to primary health care services in a timely manner is a significant factor for optimal public health outcomes. However, there is currently a notable shortage of primary health care workers, which may compromise the quality of patient care.

It has been established that practices with more than 2,000 patients per practitioner working full-time are not able to provide the level of care and access to their patients as required.

At this ratio, each primary care physician is estimated to spend more than 17 hours each day in the provision of acute, chronic, and preventative health care. This is clearly not feasible and does not include other responsibilities and paperwork associated with the position.

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Increasing the Number of Primary Practitioners

Attracting a greater number of medical students into the provision of primary health care, rather than specialization, would help increase the number of primary care practitioners. There are several ways of doing this, including:

• Reducing the income gap between primary and specialized care providers
• Improving work life of primary care physicians
• Increasing funding for primary care training
• Expanding training program for general practitioners

Additionally, addressing the panel size can also be done with a micro-level solution in the primary care team of each practice. For example, adjusting the role of the practitioners so that administrative tasks that do not require medical skills are delegated to other members of staff at the practice.

Increasing the Capacity of Practitioners

The capacity of each primary care practitioner can also be optimized to help minimize the effects of the shortage. There are two key determinants of the capacity of a practitioner: the number of hours worked and the number of patients scheduled each hour.

There are several changes that can be implemented to improve practitioner capacity. For example, follow-up appointments should only be made when required and not on a routine basis at frequent intervals. Naturally, this must be done with care to avoid compromising the quality. Delegating administrative tasks to other members of the team can also increase practitioner capacity.

Optimizing the Geographic Distribution of Practitioners

A significant problem of the shortage of primary care is the misdistribution of services. Some areas, usually in rural or remote locations, have a marked lack of access to primary health care services, especially in comparison to urban and metropolitan areas. This imbalance could be rectified in a number of ways.

For example, increased funding and incentives for practitioners who choose to work in underserved areas may help redistribute the workforce in a positive manner. It is important for these incentives to address not only financial gain but also work-life balance and other objections to working in a remote area.

Additionally, prioritized acceptance of medical students from rural backgrounds into medicine schools could have positive repercussions. Students who grew up in a rural or remote area are four times as likely than those from an urban area to work in a rural setting. Offering financial aid or scholarships to potential medical students who fit these criteria may, therefore, be beneficial.   

Moving Forward

The shortage of primary health care workers is an ongoing issue, which will require a combination of strategies to address now and in the future. It is important to continually reassess the situation and implement innovative ideas to improve the care given to all individuals, no matter where they reside.

References

• http://content.healthaffairs.org/content/29/5/799.full
• https://www.acponline.org/acp_policy/policies/solutions_challenges_primarycare_2009.pdf
• https://www.mja.com.au/journal/2011/194/11/strategic-approaches-development-australia-s-future-primary-care-workforce
• http://www.who.int/bulletin/volumes/88/5/09-070607/en/

Further Reading

• All Primary Care Content
• What is Primary Care?
• Primary Healthcare Providers
• Physician Shortage
• Challenges in Primary Care

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.