The current primary care physician (PCP) shortage is expected to worsen
According to the Association of American Medical Colleges (AAMC), the US is expected to face a shortage of PCPs ranging from 21,400 to 55,200 by 2033.1 While nurse practitioners and physician assistants who go into primary care practice may help bridge that gap, many states are still lagging far behind in passing progressive legislation to enable these mid-level providers to practice autonomously (via full practice authority) in the ways they are needed in their communities. It’s all too commonplace to see PCPs running behind in seeing patients each day in their practices because they are performing tasks that other care team support is better equipped to do. Examples of these tasks that clinic-embedded pharmacy personnel can absorb and complete successfully include prescription prior authorization management, medication therapy management, medication reconciliation, in-depth medication and disease state counseling, ordering lab tests, and approving refill authorizations. And with the recent expansion of telehealth visits and remote chart review, leveraging clinical pharmacists and technicians to navigate this work behind the scenes will be minimally disruptive to on-site clinic operations.
The aging population is rapidly changing America’s demographics
According to statistics published by the Rural Health Information Hub, by 2030, 1 in 5 Americans is projected to be 65 years old and over. Put another way, between 2020 and 2030, the number of older adults is projected to increase by almost 18 million to around 64 million. Much of this population (approximately 1 in 5) resides in rural communities, which are already disproportionately negatively impacted by limited primary care access.2 If these percentages stay the same, this will add 3.6 million new seniors to rural areas already under-resourced in primary care providers. And given that almost 3 out of 4 people age 65 and older have multiple chronic conditions, this population will continue to be a high utilizer of the healthcare system, in particular with regard to prescription drugs, supplements, and over the counter (OTC) medications. Nearly 90% of adults 65 and older currently take at least one prescription medication, with more than 50% reporting they take 4 or more prescription drugs.3 Pharmacist expertise around polypharmacy, renal and hepatic dose adjustments, drug-drug interactions, drug-disease interactions, adherence counseling, deprescribing, and transitions of care are of paramount importance in keeping seniors healthy in rural and urban communities alike and therefore should play an integral role in the holistic care that advanced primary care systems espouse.
Pharmacists’ “provider status” is gaining steam – a matter of time
Pharmacists have long stood in healthcare gaps and done whatever is necessary to ensure improved patient access and outcomes – we just haven’t been paid (or have been grossly underpaid) for those services. But those days do appear to be slowly coming to an end, with state and federal legislation in motion to recognize pharmacists equitably as healthcare providers who can bill health plans for patient care services rendered within our scope of practice. These services fall outside of dispensing medications and include chronic disease management, immunizations, disease/health screenings, point-of-care testing, and medication management. One of the ripples that this long-awaited recognition should cause is to enable/empower companies providing primary care to reimagine their service models and be more inclined to integrate pharmacy personnel into their workforce. Not only does it make sense from improved patient outcomes, interprofessional workload sharing, and cost savings perspectives, it will become revenue-generating in much more tangible, measurable ways. While there may continue to be barriers to getting federal legislation passed, pharmacists credentialed with payers, medical claims paid at higher rates, etc. for the next few years, there are still compelling patient-centered reasons for advanced primary care models to become early adopters now.