When health care industry experts decried the potential effects of the Patient Protection and Affordable Care Act, a phrase heard over and over during discussions was "provider shortage."

The U.S. Department of Health and Human Services' Health Resources and Services Administration predicted in the November 2013 report, "Projecting the Supply and Demand for Primary Care Practitioners Through 2020," that based on utilization patterns, the number of primary care physicians will increase by 8 percent by 2020, but the demand for primary physicians will increase by 14 percent, well outpacing the supply.

However, whether that shortage is a result of the increased access to health care mandated by PPACA – and whether there is actually a shortage in the first place – remains up for debate among many industry professionals.

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"I would say that there's a 'predicted' provider shortage," says Frank Bird, vice president of MDS consulting. "And how it's manifesting is varying a lot by market. In some markets that are still fee-for-service-based and where perhaps a state hasn't adopted an exchange or expanded Medicaid, there probably isn't a shortage. But if you get into some markets that are very large geographically and that are handling very large populations of Medicaid or uninsured patients, then there are definitely specialists unwilling to see patients at those lower price points."

As far as other skilled positions in health care, such as nursing, some experts believe shortage predictions have long been overblown.

"I first started as an attorney in the health arena in 1986," says Randall Fearnow, a partner at Quarles & Brady, "and I've been hearing about the nurse shortage since then. And it never seems to meet the dire predictions of the experts."

In terms of the projected physician shortage, Fearnow notes that reports of increasing consolidation in the health system via integrated delivery systems and hospitals buying up private practices might be a positive move that could help mitigate or negate a shortage.

"Individual doctors are not often very efficient at what has to be done in the modern age in order to provide care," Fearnow explains. "They're good at providing the care, but when it comes to corporate compliance, all of the billing issues, complying with HIPAA and doing all of these other management jobs that don't come naturally to physicians, it makes sense to have coordinated efforts. So I view the increasing acquisition of physician practices by hospital systems as probably not a bad thing, and probably good for efficiency. There are only so many good administrators to go around, and every three-person group cannot expect to have one."

Fearnow works consistently with skilled nursing facilities and believes the market has factored in the uptick in care required by aging Baby Boomers and beyond.

"I've observed this market continuously since the mid-1980s, and it looks like the market has factored in the Baby Boom expansion a long time ago – and probably overshot its mark," he says. "The best evidence we have of that is states attempting to restrict the number of Medicare/Medicaid certified skilled nursing beds that are out there, even though we are in the midst of the Baby Boom retirement now, which is counterintuitive to what experts are telling us about the demand.

"Part of the reason for that," he continues, "could be that even though we have a large aging population, I think we're finding that they don't really need skilled nursing care at these huge levels that were predicted. They're healthier, and they can do quite all right in assisted living; they don't need the technician-heavy types of facilities that have been built."

"The other emerging concept that we're seeing is how physicians are able to extend their practices through nurse practitioners and physician assistants," Fearnow notes. "They're discovering that they can cover a larger geographic area and see a much larger population of patients if they can do so with nurse practitioners and physician assistants who are taking care of a lot of the base work."

Bird also sees mid-level providers as a potential solution to physician shortages.

"I don't see shortages," Bird says. "I see mid-level providers being used more, but I also see them being more available. Historically, independent doctors might not have had as many of those mid-level employees as they would like, but now it's becoming more important to have those roles and use them to the best of their abilities.

"The physician has a higher level of training, and that makes it a harder position to fill," he allows. "I think we have a challenge: What does the doctor of the future look like? There might not be a shortage of doctors, but our definition of what a doctor is and does might change.

"If you're using a care path that you understand for disease prevention or chronic disease management, a lot of these mid-level roles will be great to manage those," he says. "If you have a really weird onset of something no one can figure out, then you want to talk to those old-school physicians who have seen a lot. How that varies over time is going to be interesting."

"Consolidation of institutions and physician practices will alleviate a good deal of the administrative burden," Fearnow predicts, "and I think developing technologies also will alleviate the burdens and allow the licensed professionals to become even more efficient in the future."

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