Task Force On Primary Care and Specialty Supply

The NCIOM Primary Care and Specialty Supply Task Force on was convened in 2006 to analyze current and projected trends in provider supply and to examine whether the existing production of physicians, NPs, PAs, and CNMs will address the state’s growing healthcare needs. The Task Force examined trends in provider supply including: (1) types of providers (by specialty) likely to be needed to address future healthcare needs; (2) areas of the state that experience persistent shortages; and (3) underrepresentation of certain ethnic and racial minorities in specified health professions. The goal of the Task Force’s work was to develop public and private policy options to ensure North Carolinians have access to the providers they need.
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E. Harvey Estes, Jr, MD
Chairman Emeritus, NC Institute of Medicine Board of Directors
Professor Emeritus, Department of Community and Family Medicine Duke University
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 NCIOM 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)