Primary Care and Specialty Supply
The study of the primary care and specialty workforce in North
Carolina was a collaborative effort of the NC Institute of Medicine, NC Health Professions Data System
and Southeast Regional Center for Health Workforce Studies at the Cecil G. Sheps Center for Health Services
Research at the University of North Carolina at Chapel Hill, and NC Area Health Education Centers Program.
Current data from the NC Health Professions Data System
indicate that physician growth is no longer keeping pace with population
growth in North Carolina. The goal of the study was to identify likely provider
shortages, both in terms of provider specialty (e.g., OB-GYN, surgeons,
psychiatrists, geriatricians, pediatric subspecialists, primary care) and areas of
the state experiencing persistent shortages, and to address these potential
problems before the state is in the midst of a full-blown crisis. This initiative
also examined the needs of underserved population groups (e.g., uninsured, immigrants,
frail and elderly) in determining the types of providers needed in the future.
The NC IOM study evaluated the state's past efforts to
recruit and retain health professionals, including in-state academic training and
residency programs; out-of-state recruitment and retention efforts for health
professional shortage areas; the use of international medical graduates; whether
the growth in nurse practitioners, physicians' assistants and certified nurse
midwives will offset the likely shortfall in primary care physicians; and
professional quality of life issues. The goal of this study was to develop
public and private policy options to ensure that North Carolina has an adequate
supply of providers distributed throughout the state. Some of the options may
include, but are not limited to:
- Increasing the supply of medical students (e.g., does North Carolina
need to expand existing or create new allopathic or osteopathic medical
schools or change the medical curricula);
- Increasing the number of residents trained in North Carolina residency
programs (e.g., should North Carolina expand or modify residency programs
or include more international medical graduates in the existing residency
programs);
- In-state retention efforts (e.g., how do we retain North Carolina-
trained physicians to set up and maintain practices in the state);
- Efforts to increase the availability and utilization of non-physician
mid-level practitioners, such as nurse practitioners and physician
assistants, in the provision of primary care services where supply of
physicians remains a problem;
- Out-of-state recruitment efforts (e.g., should the state expand or
change how it recruits out-of-state or international medical graduates or
offer different incentives); and
- Quality of life issues (e.g., how can North Carolina address the
quality of life issues that impact on retention in persistent health
professional shortage areas).
- New models of primary care delivery (e.g., how do we need to organize
practices to make them viable at the community level)
