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Research suggests that the ideal ratio of specialists to primary care physicians is 40 percent to 50 percent in the healthiest nations.[12]A large gap in this ratio currently exists, with only one-third of physicians working in primary care.

In states with higher ratios of specialists to primary care physicians, research indicates increased costs and decreased quality of care.[13] The ACA relies heavily on the concept of the Patient Centered Medical Home (PCMH) model and free preventive care.

The danger is that these shortages will result in increased morbidity and mortality for rural Americans.

Solving the problem will likely require a paradigm shift in educational admission practices, recruitment of more personnel with rural experiences, payment reform in the public and private sectors, and a much friendlier regulatory environment for medical practice, including tort reform. Another personnel supply problem is the disproportionate ratio of primary care physicians to specialists.

Medical education should include new incentives for primary care.

An emphasis on GME residency slots for primary care in the Medicare program might help to reverse the decline.[19] Higher Intensity of Care.

The health care workforce is already facing a critical shortfall of health professionals over the next decade.With the new demand for medical services for the millions who are expected to enroll in Medicaid and the federal and state insurance exchanges, the workforce shortages could become catastrophic.Based on a 2012 compilation of state workforce studies and reports, every state clearly needs more physicians.Without more graduates from nursing and medical schools and increased innovation in shared roles and responsibilities among doctors, nurses, and other medical professionals, individuals and families will face longer wait times, greater difficulty accessing providers, shortened time with providers, increased costs, and new frustrations with care delivery. Pent-up demand from those waiting for a plastic card and attracted by the promise of “free” or heavily subsidized services is expected.Of course, doctors, nurses, and other medical professionals want to help people in need, but the sheer logistics of expanded care delivery, the current and growing shortage of personnel, and limited resources will certainly undercut the good intentions of the policymakers who crafted the national health law.

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