The U.S. faces an impending shortage of up to 44,000 generalist physicians to care for adults, according to a study published online today by Health Affairs. The study projects outpatient visits by adults will increase 29% between 2005 and 2025 as the population ages, while the number of generalists to care for them will increase only 11%. It calls for increased funding for residency positions, noting that the shortage could be alleviated if the nation annually produced four additional generalist graduates in each family and internal medicine residency program. It also calls for reimbursement reform to make the "medical home" model financially viable. The model uses teams of physicians, nurse practitioners, and physician assistants to provide office, hospital and home care, assisted by telephone and e-mail consultations and electronic medical records.

Immigrants primarily come to the U.S. for employment, and recent immigrants tend to work in low-wage jobs that do not offer health insurance. Most recent immigrants also do not have access to public coverage through Medicaid and SCHIP, as federal law generally prohibits them from enrolling in these programs. As a result, non-citizens have a very high uninsured rate, which causes them to have poorer access to care and to receive less care than citizens. However, because they represent a relatively small share of the U.S. population, they are not
the primary driver of the nation’s growing uninsured problem. Further, even though they face greater barriers to obtaining care and receive less primary care than citizens, they have low rates of emergency room use and are significantly less likely to use the emergency room than citizens.