Maryland and the rest of the country are dealing with a shortage of primary care physicians and fear the problem will worsen when health care reform adds millions more people to the insurance rolls. Nearly 360,000 new people will have access to insurance in Maryland by 2020.
A work force investment board appointed by Gov. Martin O'Malley used a $150,000 federal grant to come up with the goals to improve the number of primary care physicians, nurses, physician assistants and support staff in the state by 2020.
A recent study by the Maryland Hospital Association and MedChi found that there are about 4,596 primary care physicians in the state, but that nearly half were hospitalists, or specialists that oversee a patient's hospital stay. Without the hospitalists, there are about 52 primary care physicians for every 100,000 residents.
Many doctors choose to enter specialties, such as orthopedics, because they say they can't make enough money as a primary care physician.
The state plan would address that by looking to improve Medicaid reimbursements beyond 2014. Compensation was recently increased through 2013.
"Unless you pay them enough so they can keep the doors open, there is a disincentive for physicians to choose primary care," said Lt. Gov. Anthony Brown. "Part of the recommendations in this plan lay out some actions to address that."
The state will also look at ways to increase the number of scholarship and loan assistance programs. The typical medical student has $135,000 in debt, not including any undergraduate debt, the report said.
Nontraditional paths to primary care work would also be explored, including further training opportunities for nurses and physician assistants. These positions will be counted on more under health care reform to perform the duties of traditional primary care physician.
CareFirst BlueCross BlueShield expanded the role of nurse practitioners — nurses with advanced education and training, who can work independently — in its network last year. The state's largest insurer now allows nurse practitioners to participate in its health care provider network as primary care physicians. Until now, CareFirst has permitted such nurses to practice independently of physicians only in underserved areas with limited access to doctors.
Health officials also found that doctors face red tape and bureaucracy. The plan will look at ways to eliminate some of that, possibly by simplifying the licensing process.
By next year, the plan calls for creating a website that includes job opportunities, training tools and recruitment incentives aimed at the primary health care field. The state also wants to collect better data.
"I think some things will be easier than others, but having a vision is the precondition for success," Sharfstein said.