Graham Center Policy One-Pager

Proportional Erosion of the Primary Care Physician Workforce Has Continued Since 2010

 

Am Fam Physician. 2019 Aug 15;100(4):211-212.

We estimate that 217,208 primary care physicians provided direct patient care in the United States in 2018. This represents an even lower percentage (30%) of the total U.S. physician cohort than the 2010 Council on Graduate Medical Education's (COGME's) recommendation to increase primary care to 40% of the overall physician workforce.

In 2010, the congressional advisory group COGME declared in its 20th report that “policies supporting physicians providing primary care should be implemented that raise the percentage of primary care physicians (general internists, general pediatricians, and family physicians) among all physicians to at least 40 percent from the current level of 32 percent, a percentage that is actively declining at the present time.”1 We used data from the 2018 American Medical Association Masterfile and the same methods of calculation as COGME to assess progress toward the recommendation, using an established method to account for hospitalists—physicians with primary care specialty training working primarily in hospitals (more than 90% of claims;2  Table 1 and Table 2). We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3

 Enlarge     Print

TABLE 1

National Physician Estimates, 2018

Physician typeNo. of physicians% of all physicians

Non-PC physicians

479,839

66%

PC physicians

217,208

30%

Hospitalists*

29,068

4%

Total physicians

726,115

100%


CMS = Centers for Medicare and Medicaid Services; PC = primary care.

*—Physicians with PC specialty training working primarily in hospitals (more than 90% of claims).

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare.

TABLE 1

National Physician Estimates, 2018

Physician typeNo. of physicians% of all physicians

Non-PC physicians

479,839

66%

PC physicians

217,208

30%

Hospitalists*

29,068

4%

Total physicians

726,115

100%


CMS = Centers for Medicare and Medicaid Services; PC = primary care.

*—Physicians with PC specialty training working primarily in hospitals (more than 90% of claims).

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare.

 Enlarge     Print

TABLE 2

National PC Physician Estimates, 2018

PC physician typeNo. of physicians% of all physicians% of PC physicians

Family medicine

86,958

12%

40%

General internal medicine

72,404

10%

33%

General pediatrics

49,410

7%

23%

General practice

4,620

1%

2%

Geriatrics

3,816

1%

2%

Total PC physicians

217,208

30%

100%


CMS = Centers for Medicare and Medicaid Services; PC = primary care.

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3 The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare.

TABLE 2

National PC Physician Estimates, 2018

PC physician typeNo. of physicians% of all physicians% of PC physicians

Family medicine

86,958

12%

40%

General internal medicine

72,404

10%

33%

General pediatrics

49,410

7%

23%

General practice

4,620

1%

2%

Geriatrics

3,816

1%

2%

Total PC physicians

217,208

30%

100%


CMS = Centers for Medicare and Medicaid Services; PC = primary care.

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3 The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare.

Family physicians are the largest contributor to the primary care physician workforce, making up 40% of all primary care physicians, followed by general internists and general pediatricians. With 40% of U.S. family physicians being older than 55 years,4 and substantial proportions of primary care residents choosing to subspecialize or become hospitalists, primary care access is likely to worsen. The shrinking proportion of primary care physicians does not reflect the growing demands of an aging U.S. population. Primary care physicians are more likely to provide care in rural areas and safety net settings relative to other subspecialties.5

Among noteworthy advocacy responses to these trends, major U.S. family medicine organizations have collectively declared a “25 by 30” goal, hoping to see 25% of all U.S. medical school graduates selecting the primary care discipline by 2030.6 Still, the need for policy attention to these developments is even greater and more acute today than in 2010. Evidence-based reforms are needed to enhance educational exposures, graduate medical education financing, and downstream payment for learners interested in primary care, while also reducing burnout.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Council on Graduate Medical Education. Twentieth report. Advancing primary care. December 2010. Accessed March 20, 2019. https://bit.ly/2LypPH1...

2. Kuo YF, Sharma G, Freeman JL, et al. Growth in the care of older patients by hospitalists in the United States. N Engl JMed. 2009;360(11):1102–1112.

3. Petterson SM, Rayburn WF, Liaw WR. When do primary care physicians retire? Implications for workforce projections. Ann Fam Med. 2016;14(4):344–349.

4. Wilkinson E, Bazemore E, Jabbarpour Y. Ensuring primary care access in states with an aging family physician work-force. Am Fam Physician. 2019;99(12):743. Accessed July 16, 2019. https://www.aafp.org/afp/2019/0615/p743.html

5. Petterson S, McNellis R, Klink K, et al.; Robert Graham Center. The state of primary care in the United States: a chartbook of facts and statistics. January 2018. Accessed March 20, 2019. https://bit.ly/322arZ8

6. Kelly C, Coutinho AJ, Goldgar C, et al. Collaborating to achieve the optimal family medicine workforce. Fam Med. 2019;51(2):149–158.

The information and opinions in this article do not necessarily reflect the views or policy of the AAFP.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Graham Center Policy One-Pagers published in AFP is available at https://www.aafp.org/afp/graham. Policy One-Pagers are available from the Graham Center at https://www.graham-center.org.

 

 

Copyright © 2019 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


More in Pubmed

MOST RECENT ISSUE


Nov 1, 2019

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article