New Data Brief Finds Physician Shortages Lead To Network Adequacy Challenges

by Alicia Caramenico

July 18, 2016

States are facing a shortage of physicians in primary care, psychiatry, obstetrics and gynecology, and general surgery, according to a new AHIP data brief. This analysis looked at the ratio of these physicians to the population and found several U.S. states currently have physician supply rates that fall well below the national average.

According to the data brief, these provider shortfalls may be even more severe in rural areas. While close to a quarter of Americans live in rural areas, only 10 percent of physicians practice in those geographies. For example, most surgeons in Idaho are practicing in urban areas (25 per 100,000 urban population) rather than in rural areas (14 per 100,000 rural population).

Health plans are required to meet network adequacy standards, ensuring health plan provider networks offer consumers access to sufficient numbers and types of providers. This analysis suggests that for national or state-level adequacy standards to truly protect consumers, they must take into account differences in physician supply and distribution. A lack of available primary care physicians or specialists in a geographic area may reduce the ability of health plans to form networks of physicians in that area, especially high-value networks, making it difficult to offer higher-quality, lower-cost services to consumers.

With the shortages expected for major physician specialties by 2025, the analysis also highlights several policy proposals to increase physician supply, such as expanding the innovative use of telemedicine or giving nurse practitioners and physician assistants more freedom to provide medical services.