Strategy, stratification and the role of higher education in training more primary care physicians in the era of the Affordable Care Act

Increased access to primary care is the bedrock upon which the Patient Protection and Affordable Care Act (ACA) is founded, thereby necessitating growth in the health care workforce. This multiple case study explores how within the field of medical education strategic actors are varying institutional strategies in response to the incentives in Title V Health Care Workforce to educate and train more primary care physicians. It also examines how the legislation may be exacerbating existing stratification within medical education in a single state. Findings suggest that the ACA fails to address the main impediment of increasing the primary care physician supply, signaling that the shortage of physicians will continue or that other health professions will subsume more primary care responsibilities. Furthermore, strategic action in response to the ACA is partially based on the prestige economy and thus can be explained by a commitment of academic leaders to maintain stratification within medical education.