The National Residency Exchange: A Proposal to Restore Primary Care in an Age of Microspecialization

Abstract

Healthcare deficiencies in the United States have long been perpetuated by a shortage of primary care providers. A core purpose of the Patient Protection and Affordable Care Act (PPACA) is to provide health insurance for America's approximately fifty million uninsured. Implementation of universal health insurance, however, does not mean sufficient healthcare access for all, since the supply of physicians does not and will not meet demand. For reasons reviewed in this Article, the current physician shortage mainly impacts primary care providers. This shortage is particularly troubling because increased provision of primary care relative to specialty care has been associated with improvement in health outcomes, disease prevention, cost effectiveness, and coordination of care. This Article highlights provisions in the PPACA that impact primary care physicians. Finally, this Article proposes the creation of a universal primary care loan repayment program and a national residency exchange designed to alleviate the U.S. primary care crisis by facilitating optimal distribution of resident physicians in each medical specialty based on community need.

Access to care based on state nurse practitioner practice regulation: Secondary data analysis results in the Medicare population

“…With the approaching healthcare coverage of 32 million Americans who have been previously uninsured, policy makers will be instrumental in finding ways to provide health care to this previously uncovered group (Goodson, ). Recommendations targeted at increasing the supply of primary care physicians support universal loan repayments as outlined in the Affordable Care Act and propose national residency exchanges (Cheng, ). However, even more research and health policy change is needed in order to make a significant impact on access to care.…”

“…Recommendations targeted at increasing the supply of primary care physicians support universal loan repayments as outlined in the Affordable Care Act and propose national residency exchanges (Cheng, 2012). However, even more research and health policy change is needed in order to make a significant impact on access to care.…”

Incentives for Physicians to Pursue Primary Care in the ACA Era

“…In addition, Medicare allowed certain residency training slots to be redistributed among departments within an institution to high-need specialty areas [50]. The residency slots redistribution, though a step in the right direction, has been anticipated to have minimal impact [51].…”