Summary
Michigan’s primary-care workforce shortage is driving long waits and leaving some patients without follow-up care, a group of physicians said Tuesday, urging the state to respond by paying more for “foundational” services.
In a 14-point plan released by the Michigan State Medical Society, leaders argued that Michigan has underinvested in primary care, and that increasing pay and reimbursements would help expand access and reduce missed care. The society linked the shortage to patient access problems as well as system pressures, saying the consequences include higher costs and gaps in care.
The plan says primary care currently receives 5% of total medical expenditures, and calls for raising that share to 12%. Dr. Tom George, an anesthesiologist and the society’s chief executive officer, said in releasing the proposal that “Michigan has made an underinvestment in primary care.”
The society said federal estimates show Michigan is short at least 464 primary care providers. It also pointed to what it described as a pay gap, saying primary care doctors average $287,000 per year nationally, compared with $404,000 for specialists. George said the group wants to prioritize primary care spending as other health care expenditures grow.
The report also addressed demographics, saying Michigan’s population is aging faster than in most states. It said 1.9 million residents—nearly 1 in 5—are already 65 or older, and added that age-related conditions further strain the health care system.
George contrasted the proposal with shifting funds away from specialists, saying, “This is not ‘Let’s just pay the neurosurgeons less than we’ll pay primary care,’” and adding that “We’re talking about the big pie of health care spending” as it grows. While the report stopped short of dictating specific steps for spending more on primary care, it highlighted other state requirements for primary-care spending by payers.
The society cited Oregon’s requirement that 12% of Medicaid dollars be spent on primary care, and said Rhode Island mandates that commercial insurers invest at least 10% on primary care. The report also said more than 1 in 4 Michiganders—about 2.7 million—live in Health Professional Shortage Areas, which it described as a federal designation based on provider counts, residents’ poverty levels, and travel time to nearest providers outside the designated area.
Beyond payments, the society focused on how primary-care practices could build teams to handle more patient needs in-person. Dr. Dennis Ramus, the report’s lead author, said the increased resources would allow practices to add at least a nurse case manager and an advanced practice clinician such as a nurse practitioner or physician assistant, and potentially other roles including pharmacists, social workers and psychologists. He said patients can receive much of what they need through that approach, saying, “I can generally take care of 65% of what you need done if you call me first.”
Ramus said the proposal also aims to address the way “teams” are sometimes implemented in ways that do not improve access, describing what he called an “illusion of a team.” He also said Michigan retains less than half of the primary care physicians it trains, according to the report.
The plan’s recommendations included broad payment reforms in primary care, recommending that Medicaid and commercial payers abandon fee-for-service payments in primary care. It also called for Michigan to create a hub to provide practices with services such as accounting, billing and electronic health records, and to establish pre-medical apprenticeship programs to recruit medical students from “communities of need.”
Other recommendations in the plan included boosting funds to allow medical students to pay off student loans, and expanding incentives for new doctors to practice in underserved areas. The report also said Michigan is considering steps such as expanding responsibilities for nurse practitioners, which some have argued could increase access, while noting that the doctors’ group has opposed independent work by those clinicians and said they should work as part of a physician-led team.
The report said Michigan is also weighing temporary licenses for doctors who earned degrees outside the U.S. or Canada, alongside continued participation in an interstate compact that allows providers licensed in other states to practice in Michigan.
Dr. Brad Uren, an emergency medicine doctor in Ann Arbor and vice chair of the society’s board of directors, said emergency rooms often see patients who need follow-up care but lack a primary care doctor for reasons that include barriers to accessing a regular provider. He described follow-up needs he often discusses with patients after emergency treatment and said, “you really need somebody to quarterback that care,” to coordinate ongoing monitoring and treatment.
As the society framed the proposal, it said primary care serves as triage for specialist care, sending appropriate patients to specialists when needed, and said that foundation helps create a more effective overall system.