America’s health care system is overburdened, with rising costs, bureaucracy, and medical worker shortages all making it harder for Americans to get the quality health care they deserve. One-size-fits all solutions to these challenges will not deliver better health for more people at lower costs. That’s why Stand Together Trust has for years collaborated with partners that embrace innovation and empower patients and doctors with solutions that are personal and relevant to them.
One of those grantees, Institute for Reforming Government, recently worked with Tomas J. Philipson to publish a policy brief offering solutions to the primary care doctor shortage in Wisconsin. Philipson holds the Daniel Levin Chair in Public Policy at the University of Chicago and previously served as the Acting Chairman of the Council of Economic Advisors in the Trump Administration. He has been frequently called to testify before Congress on health care policy.
The policy brief, “Increasing Health Care Choice and Competition in Wisconsin,” was co-authored with colleagues Stefano Bruzzo-Gallardo and Ruiquan Chang. Focused on problems specific to Wisconsin, the report identifies four areas of state and federal level reform. Indeed, some of the solutions could be used across the nation.
One particularly troubling issue the authors examined is the current and growing doctor shortage. The Philipson report found that by 2030 some 36 states are expected to have a physician shortage. Nationally, it is projected that by 2030 America will be short 121,000 doctors.
Rising health care costs, unnecessary government restrictions, increasing sickness, and more insured patients are all contributing to a system that can’t keep up with the needs of its consumers.
Policymakers and leaders in health care have an opportunity to help alleviate the doctor shortage with some commonsense reforms that we know will work. Certain states, like Wisconsin, where the shortage of physicians is expected to exceed 2,000 by 2035, have been working for years to adopt changes to mitigate the shortage.
“We need new solutions. We need a new way to look at health care, and the time is now, and the state can do it,” Alex Ignatowski, IRG’s director of State Budget and Government Reform, told Spectrum News. “Certainly, folks, when they think about health care, they think about the federal level, but your state has a lot of influence about what happens in your health care system.”
Interested policymakers and health care leaders can read IRG’s recommendations and the entire report here. Stand Together Trust briefly summarized a few of the recommendations in the following paragraphs.
Recommendation #1. Expand the Scope-of-Practice (SOP) of Nurse Practitioners (NPs)
In 22 states and the District of Columbia, NPs can “evaluate patients, diagnose, order and interpret diagnostic tests; and initiate and manage treatments” as stated by the American Association of Nurse Practitioners. In other words, they can do a lot of the same basic functions that doctors do. Unfortunately, state scope of practice laws often restrict what NPs can do or require oversight by a physician.
“Extremely rigid collaborative practice agreements and other burdensome forms of physician supervision are generally not justified by legitimate health and safety concerns,” the Philipson study explains.
Allowing nurse practitioners to practice to the full extent of their training has a track record of success. Phillipson and his fellow researchers found evidence to suggest that waiving scope-of-practice requirements for NPs during the COVID pandemic led to fewer cases and that expanding SOP in other states could have prevented COVID-related deaths. Additionally, the researchers highlight evidence that expanding scope-of-practice for nurse practitioners has “a 2.5-fold greater likelihood of patients receiving primary care from NPs than states with restrictive SOP laws.”
Said another way, expanding the scope-of-practice of nurse practitioners doesn’t completely solve the doctor shortage, but it would help patients in Wisconsin get access to quality medical care they need and deserve and take some pressure off doctors in the process.
Recommendation #2. Grow the supply of Doctors of Medicine (MDs)
More students are applying for medical school, but the rate of acceptance has not increased proportionally. According to Philipson and his fellow researchers, the national acceptance rate has gone from 52% in 2002 to 30% in 2021. The state of Wisconsin lags significantly behind other states with a rate of 30.8 students to 100,000 inhabitants; the national median is 38.6 students. With the population of the state expected to grow, demand for care will also grow, and the supply of doctors is failing to keep up.
To fix this problem, according to “Increasing Heath Care Choice and Competition in Wisconsin,” the state should:
- Increase acceptance rates at medical schools in the state. “A higher supply of MDs would increase the overall supply of physicians in the state along with reducing the market concentration of healthcare services by expanding the total supply of healthcare providers.”
- Consider adopting laws that allow physicians to be licensed to practice in more than one state or gain licenses in others states more quickly.
- Expand telehealth care. “[T]elehealth healthcare services can enhance price and non-price competition, reduce transportation expenditures, and improve access to quality care in underserved locations.”
- Easing or expediting the process to accept foreign-trained doctors, which would be unlikely to compromise quality of care and could help states like Wisconsin increase their supply of MDs.
The demand for health care services is only going to grow. And you don’t need an economics degree to understand what happens when demand goes up and supply goes down — prices skyrocket. It’s an untenable situation. Americans can’t allow policymakers and health care leaders to sit on the sidelines and let others solve problems like increasing patient access to quality primary health care.
Learn more about the Institute of Reforming Government here.
Download the “Increasing Heath Care Choice and Competition in Wisconsin” report: