Watch this overview of 14 recommendations across four key priorities aimed at addressing Michigan’s growing physician workforce challenges.
Executive Summary
In Michigan today, almost a third of the population lacks access to primary care. Costs are continually escalating, and the population is growing sicker. Over 30% of current physicians are over 60, and Michigan is only retaining 45.6% of the resident Graduate Medical Education physicians it trains. Physician shortages and underinvestment are even more dire in primary care, which is the first point of contact for most patients and the cornerstone of a high-performing health system.
In this spirit, the Michigan State Medical Society (MSMS) Board of Directors created a Subcommittee on Michigan’s Physician Workforce Needs to inform solutions to strengthen the healthcare system and improve population health. Experts from organized medicine, academic medicine, health policy, and private and governmental payers and agencies collaborated to probe the current state, root causes, and key strategies. This report summarizes their findings and recommendations.
Given the skyrocketing cost of healthcare, the subcommittee focused on proposals that were cost-neutral and actionable. Since high-quality primary care is the foundation of a robust, effective, and efficient system—and the most essential element for improving the overall health of Michigan residents—many of the recommendations focus on primary care.
The focus on primary care does not negate the importance of ensuring appropriate capacity for all medical specialties and the need to address those shortfalls in the future; however, subcommittee members recognized that without access to a robust primary care physician workforce, Michigan residents cannot attain their goals related to chronic care prevention and management.
The subcommittee’s recommendations focus on four areas:
- reforming primary care payment
- reducing the systemwide administrative burden
- reimagining the training and education of primary care physicians
- better recruitment and retention of primary care physicians to practice in Michigan.
Effectively implemented, these recommendations have the power to transform Michigan’s primary care landscape, ultimately improving healthcare for all. Additional public benefits include greater social equity, a significant reduction in avoidable costs, and increased productivity.
The clock is ticking. Each day Michigan waits to strengthen and improve its primary care system, the greater the crisis grows.
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Recommendation 1
Pass a legislative primary care spending target in Michigan of 12% of total medical expenditures so primary care physicians can employ care teams comprised of RN Care Managers, advanced practice providers (NPs/PAs), community health workers, and other health care team members as appropriate for the practice panel.
Recommendation 2
All payers (Medicaid, commercial, etc.) should transition their fee-for-service primary care payment models to a hybrid primary care payment model.
Recommendation 3
Encourage health systems, physician organizations, and similar entities to sign on to a voluntary compact to channel enhanced primary care investment funding to the practice level, ensuring practices can resource teams.
Recommendation 4
Utilize a common set of quality metrics such as CMS’ Universal Foundation across health plans in Michigan.
Recommendation 5
All payers should agree upon and use a common attribution methodology, which should emphasize voluntary attribution across all product lines that honors a member’s choice of primary care provider.
Recommendation 6
Explore the creation of a public benefit corporation to serve as a hub to ease the administrative burden experienced by independent primary care physician practices.
Recommendation 7
Work with payers and the state to fund targeted financial and technical assistance for small, independent, and rural practices to help them adopt technology that streamlines operational and clinical tasks, including incentives for interoperable solutions that seamlessly integrate with existing EHRs to reduce duplicative data entry and minimize workflow disruptions.
Recommendation 8
Adopt uniform policies that support transparency, independent validation, and continuous auditing of clinical AI tools , ensuring they are safe, effective, and trustworthy for use in medical practice.
Recommendation 9
Encourage students from communities of need through the development of pre-medical apprentice programs and early educational pathways to medicine.
Recommendation 10
Develop and fund community-based, primary care-focused special pathways to encourage graduating residents to return to their communities or remain in similar ones.
Recommendation 11
Increase the proportion of medical school graduates who choose a primary care specialty by encouraging medical schools to develop focused curricula and/or targeted pathways that provide 65–70% of cognitive and procedural care in a team-based model, as well as internal policies designed to change attitudes and negative bias toward primary care to encourage the brightest and best students into primary care.
Recommendation 12
Leverage Physician Organizations (POs) to strengthen the physician workforce pathway by establishing residency and fellowship partnerships within PO-affiliated practices; work with POs to identify geographic and specialty shortages using claims and workforce data, and deploy targeted recruitment strategies such as incentives and loan repayment programs to encourage physicians to practice in high-need rural and underserved areas.
Recommendation 13
Establish new funding sources to expand loan repayment and establish student incentive scholarship programs, such as:
- Increase funding to MIDOCS to enable the program to expand annually.
- Amend the statute regulating the Michigan Health Endowment Fund to add the primary care workforce as a priority focus, in addition to children and seniors. Allow for funds to be used to develop targeted loan repayment and/or practice establishment
pilot programs for physicians who commit to practice in rural, medically underserved areas for seven years. - Encourage health plans, insurers, and businesses to leverage their respective foundations to invest in establishing and maintaining scholarship programs that support pathways to residency for graduating high school seniors.
Recommendation 14
Provide financial incentives to encourage primary care physicians to practice in underserved areas in community-based settings.