According to a report co-authored by Alfred Talia, chairman of the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, the shortage of primary-care physicians is endangering US residents in general and New Jersey residents in particular.
Anyone who has tried to schedule a non-emergency visit understands the problem. Existing patients often wait months; Others struggle to find a doctor who is even taking new patients. Many people don’t get care until minor problems become urgent.”
Alfred Talia, Chair of the Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School
“Most of these problems stem from money,” Talia added. “Primary-care doctors make less than specialists in the United States, so we have very few primary-care doctors compared to the number of specialists. Primary-care doctors make less in New Jersey than in other states, so the people we train here tend to go elsewhere. And the deficit is worse in New Jersey than in other states.”
Primary care has been proven to reduce mortality, serious health conditions, population health disparities and health care costs, Talia said, yet it remains underfunded, especially in New Jersey.
The report said-; Primary care in New Jersey: Findings and recommendations to support improved primary care -; Less than a third of physicians practicing in the United States provide primary care, compared to more than half of physicians in the 38 countries that make up the Organization for Economic Cooperation and Development (OECD). The share of US health care spending devoted to primary care fell from 6.5 percent of total health spending in 2002 to 5.4 percent in 2016 to 4.6 percent in 2020, while such spending remained at 7.8 percent or more in other OECD countries.
In turn, New Jersey spends less on primary care than other states. New Jersey Medicaid pays primary-care doctors half of what Medicare pays. Commercial losses -; who pay an average of 120 percent of the nationwide Medicare rate to primary-care providers -; Medicare rates in New Jersey pay an average of 93 percent. Some small New Jersey practices receive 75 percent of Medicare rates to negotiate higher reimbursements with insurance companies with little leverage. In fact, New Jersey ranks 48thm Primary care costs outside of 50 states.
Low pay leads many primary-care doctors who train in New Jersey to leave the state. New Jersey ranks 10th nationally in primary care residents and fellows but 32nd nationally in retention of these people after completing their training.
According to 2023 survey data from the State Board of Medical Examiners, New Jersey has about 5,300 doctors in the primary-care fields of family medicine, general internal medicine and geriatrics. But half of them work full time.
The report, compiled for the New Jersey Health Care Quality Institute by representatives of health care providers and insurers, recommends three major steps to help address the shortage and help New Jersey residents have easier access to the primary care that will help them live longer and healthier lives.
- Raise Medicaid reimbursement rates for primary care to Medicare levels and direct Medicaid managed care organizations to do the same.
- Use its regulatory power to shift doctor compensation away from the historic fee-for-service model and toward an improved primary-care model, where doctors are paid to keep patients well rather than treat them when they’re sick.
- Better track care numbers and medical costs and use data to track improvements.
Talia said the effort to move from fee-for-service to advanced primary care echoes a major national report authored by a group that included Shauna Hudson, vice chancellor of Rutgers Health, that aims to expand American life by “aligning our primary care practices with those that People are much healthier in the country than here.”
“Other recommendations are specific to New Jersey, and they may ease the worst problems in New Jersey,” Talia added. “We’ve seen several other states, including Oregon, Massachusetts and Rhode Island, work to reduce major primary care shortages by adjusting rates.”