What We're Reading

Health Policy Journal Club, February 2023

Corporate Investment in Primary Care

The health policy journal club is an interdisciplinary, inter-professional group convened monthly by the Farley Health Policy Center to discuss timely topics in health policy. A curated selection of high-yield articles provides the basis for discussion. Past topics have included income inequality and health, professionalism in medicine, patients as consumers, and adjusting payment for measures of social risk. This page presents the reading list from the most recent journal club.

Readings

Emerging trends in the primary care landscape 

  1. Landon BE, Weinreb G, Bitton A. Making sense of new approaches to primary care delivery: a typology of innovations in primary care. NEJM Catalyst. May 9, 2022. 

Corporate investors and primary care  

  1. Ikram U, Aung K, Song Z. Private equity and primary care: lessons from the field. NEJM Catalyst. November 19, 2021. 
  2. Shah S, Rooke-Key H, Fuse Brown EC. Corporate investors in primary care - profits, progress, pitfalls. NEJM. 2023;388:99-101.
  3. MedPAC. Congressional request: Private equity and Medicare. June 2021.
  4. Sachdev R, Scully T, Selig J, Vorhoff R. Private Equity Investors in Primary Care. Primary Care Transformation Summit.  (Can register for free access; this talk is under Day 2, second to last recording).
  5. Ramsey Pflanzer L. Amazon has been trying to break into healthcare for years. Here's a look at everything it's done. February 15, 2023. 

Physician response to a profit-driven system  

  1. Berwick DM. Salve Lucrum: the existential threat of greed in US health care. January 30, 2023. 
  2. Crowley R, Atiq O, Hilden D for the Health and Public Policy Committee of the American College of Physicians. Financial profit in medicine: a position paper from the American College of Physicians. Annals of Internal Medicine. October 2021. 
  3. Reinhart E. February 5, 2023. Doctors aren't burned out from overwork. We're demoralized by our health system. The New York Times.

Background

Retail-owned, insurance-owned, and investor-backed approaches to primary care have skyrocketed in the past several years. From 2010-2021, the capital raised for private investment in primary care leapt from $15 million to $16 billion. Amazon recently bought One Medical for $3.9 billion, and CVS Health bought Signify Health for $8 billion (Shah et al). These articles describe the current landscape of these approaches, their potential benefits, and concerns. (Notably, in our journal club discussion of the Landon et al article, participants expressed some disagreement about the typology used and how primary care was defined).  

    Archives

    Physician Workforce and Supply

    Aug 1, 2021

    Health Policy Journal Club, August 2021

    Physician Workforce and Supply

    The health policy journal club is an interdisciplinary, inter-professional group convened monthly by the Farley Health Policy Center to discuss timely topics in health policy. A curated selection of high-yield articles provides the basis for discussion. Past topics have included income inequality and health, professionalism in medicine, patients as consumers, and adjusting payment for measures of social risk. This page presents the reading list from the most recent journal club. 

    Readings

    IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. Washington, DC: AAMC; 2021. 

    1. Introduction, Updated Projections, and Conclusions - pages 1-18 and 58-60 
    2. COVID-19 Physician Workforce Implications and Evolving Care Delivery System Demand Implications - pages 19-23 and 47-52   
    3. Providers Required if US Achieved Equity in Health Care Utilization and Geographic Distribution of Physician Demand - pages 24-26 and 53-57 

    Pediatric subspecialty workforce supply and demand 

    1. Catenaccio E, Rochlin JM, Simon HK. Association of Lifetime Earning Potential and Workforce Distribution Among Pediatric Subspecialists. JAMA Pediatrics. 2021. 
    2. Freed GL. The pediatric subspecialty workforce is more complex that meets the eye. JAMA Pediatrics. 2021. 
    3. Keller DM, Davis MM, Freed GL. Access to pediatric subspecialty care for children and youth: possible shortages and potential solutions. Pediatric Research. 2020;87:1151-1152.

    Context

    This report from the Association of American Medical Colleges argues that the projected demand for physicians exceeds supply, with a projected shortage between 37,800 and 124,000 physicians overall - including 17,800-48,000 primary care physicians - by 2034. At journal club, attendees discussed controversy around these estimates: other analyses have suggested that the rate of producing physicians is exceeding population growth and that the United States has a problem of maldistribution rather than a physician shortage. In pediatrics, maldistribution of subspecialists is an issue in particular. Funding for graduate medical education is not designed to address population needs and contributes to the problems of physician maldistribution. Programs for loan repayment like the National Health Service Corps that require working in an underserved area are valuable to shift workforce distribution.