Primary care is the backbone of a high-performing health system, and yet too many providers are struggling with unsustainable workloads and burnout. A recent survey found that 1 in 5 clinicians planned to leave their primary care practice within the next 3 years due to feelings of severe burnout and exhaustion.
Today, we shared our perspective with members of the on how to address our current healthcare workforce shortage through dedicated funding and tailored support for primary care. We’re proud to be working with forward-thinking policymakers, payers and providers to ensure our nation's healthcare workers have the resources they need to deliver high-quality, patient-centered care. See below for the full letter:
March 20, 2023
To Members of the United States Senate Committee on Health, Education, Labor, and Pensions:
Thank you for the opportunity to respond to the request for information (RFI) on the healthcare workforce shortage. Waymark is a physician-led public benefit corporation that partners with payers and providers to improve outcomes for people receiving Medicaid benefits. As an organization dedicated to supporting primary care providers (PCPs), we thank you for the important investments you made to support healthcare workers across the country amid the COVID-19 pandemic. Primary care is the backbone of a high-performing health system, and yet too many providers are struggling with unsustainable workloads and burnout — and the pandemic only exacerbated these challenges. Solving the healthcare workforce shortage will require dedicated funding and tailored support to reduce burnout and attrition among PCPs.
We are grateful for the opportunity to share our perspective on factors contributing to the healthcare workforce shortage as well as potential solutions to address it.
While the national shortage of healthcare workers is alarming, this moment of crisis is also an opportunity to take long overdue steps to strengthen the healthcare safety net, reduce barriers to quality care, and ultimately better meet the needs of underserved communities. We stand ready to work with you to address these challenges and ensure our providers have the support they need to deliver high-quality, patient-centered care.
Drivers of Healthcare Workforce Shortages
Among PCPs, burnout and attrition are the main factors contributing to the current workforce shortage. A 2022 survey found that 1 in 5 clinicians planned to leave their primary care practice within the next 3 years due to feelings of severe burnout and exhaustion. The root causes of PCP burnout and attrition include:
- High administrative burden: Studies have shown that up to 24% of a physician’s time is spent on administrative duties not directly related to patient care and that don’t require a medical degree. Excessive administrative requirements have the effect of displacing other critically important work of physicians, such as reflecting on clinical decisions or allowing adequate time for self-education, and often requires them to sacrifice their personal or family time. Additionally, high administrative burden may result in the avoidance of new physicians entering generalist PCP careers.
- Broken payment models: Traditional fee-for-service (FFS) payment models reward providers based on volume of patients they see and quantity of services they deliver, regardless of quality of care or patient outcomes. As both a workflow and financial model, it prioritizes procedural over cognitive specialties and does not support providers’ ability to prevent illness, maintain wellness, build a strong physician-patient relationship, or provide whole-person care to address social or economic factors that extend beyond the clinic. Most providers enter medicine to deliver the best possible quality of care for their patients, and their inability to do this within the confines of the traditional FFS system can result in significant moral injury and disillusionment of the workforce.
- Lack of integration between physical and behavioral health: Many individuals receiving care for behavioral health conditions also have physical health conditions that require medical attention, and the inverse is also true. Given the widespread barriers to accessing behavioral healthcare — including provider shortages, high out-of-pocket costs, and gaps in insurance coverage — many people seek treatment from their PCPs. However, PCPs often feel unprepared to manage patients’ mental health or substance use concerns, especially when their conditions are more severe. This challenge is particularly acute given the nation’s growing behavioral health needs.
- Lack of team-based support: Patients with complex medical or behavioral health needs often require a multidisciplinary care team, including therapists, pharmacists, care coordinators and community health workers (CHWs). This is particularly true for patients enrolled in Medicaid programs. However, most primary care practices lack these resources and the burden to address gaps in care falls on the PCP. The chronic shortage of therapists in the U.S. — due in part to low payment rates — makes it difficult for patients to find support elsewhere. This often results in excessive workload and burnout among PCPs.
Addressing the healthcare workforce shortage will require dedicated funding and tailored support to reduce burnout and attrition among PCPs. Potential solutions should prioritize improving primary care delivery and investing in our public health infrastructure.
Improving primary care delivery
- Reduce administrative burden for PCPs: Policymakers should assess opportunities to reform Evaluation and Management (E/M) documentation guidelines for providers participating in federal programs like Medicaid. Additional funding for research to evaluate the impact of specific administrative task alternatives, automations, and offloading strategies on provider wellbeing and patient outcomes would also help reduce unnecessary work for PCPs.
- Scale value-based payment models: Transitioning from a FFS payment model to value-based payment models can incentivize providers to deliver higher quality, whole-person care and improve patient outcomes. Value-based models allow PCPs to engage and build trust with patients without having to worry about meeting a quota to ensure payment. Policymakers should consider ways to scale value-based payment models in federal programs like Medicaid.
- Integrate primary care and behavioral health: Integrated care is vital to expanding access to behavioral health services and ensuring PCPs have the resources to treat patients with complex needs. Integration is also an important strategy for addressing racial, ethnic, and geographic behavioral health disparities. We recommend increasing payment rates and creating financial incentives to coordinate care between primary care providers and behavioral health clinicians.
- Invest in multidisciplinary, community-based care teams: Numerous studies have shown that community-based care can improve patient outcomes. Community-based teams of CHWs, pharmacists, and therapists can also reduce PCP burnout by allowing them to offload tasks that don’t require a PCP, such as prior authorization and social services paperwork. Moreover, investing in community-based teams can incentivize hiring individuals from the communities they serve – ultimately building a new workforce of individuals with lived-experience and often more capable of building trust with patients. Policymakers should evaluate ways to scale community-based care teams in federal programs including Medicaid.
Investing in public health infrastructure
- Subsidize CHW training and certification programs: CHWs can meaningfully expand the existing healthcare workforce and improve access for underserved communities. These frontline workers play an important role in helping PCPs build relationships with hard-to-engage patients through outreach, accompaniment and navigation services. Policymakers should consider increasing coverage for CHW services and subsidize national training and certification programs to increase the supply of CHWs.
- Reduce regulatory requirements associated with cross-state licensure for therapists and pharmacists: Currently, varying state-by-state licensing requirements make it difficult for both behavioral health clinicians and pharmacists to provide care across states, which often deprives families in rural areas of much-needed care. We recommend a comprehensive review of interstate licensing capabilities and the creation of an incentive for states to participate in licensure reciprocity or compact, which would increase access to care in states with a shortage of clinicians.