The United States likely will need almost 52,000 additional primary care physicians by 2025 to meet the country's health care utilization needs. That's the conclusion reached by a team of researchers whose work is highlighted in an article titled "Projecting U.S. Primary Care Physician Workforce Needs: 2010-2025.(www.annfammed.org)" The research was published in the November/December Annals of Family Medicine.
The research team sought to put a number on the anticipated demand for primary care physicians following passage of the Patient Protection and Affordable Care Act (ACA). The law will add 34 million people to the ranks of Americans with health insurance coverage.
However, researchers found that a trifecta of circumstances led by population growth, exacerbated by the aging of the population and fueled by the health insurance expansion would drive the demand for primary care doctors.
Specifically, the authors said the country would need
- 33,000 additional primary care physicians to account for population growth,
- 10,000 more physicians to accommodate an aging population, and
- more than 8,000 additional physicians to cover people previously uninsured.
Researchers estimated that America's current primary care workforce would need to expand by 3 percent between 2010 and 2025 to keep up with the country's health care demands.
- Researchers project that America will need an additional 52,000 primary care physicians by 2025.
- The increased demand is the result of population growth, population aging, and health insurance expansion.
- The Patient Protection and Affordable Care Act is responsible for adding 34 million Americans to insurance rolls.
According to corresponding author Winston Liaw, M.D., M.P.H., an assistant professor at Virginia Commonwealth University's Fairfax Family Medicine Residency program, the data collected by the research team would help policymakers identify specific geographical areas most likely to experience a physician shortage.
"At the end of the day, hopefully these data can be used to help improve patient access to care," said Liaw in an interview with AAFP News Now.
Liaw noted that other researchers predicted less severe physician shortages that ranged from 44,000 to 46,000 physicians.
"Our number (52,000) is a little larger primarily because (unlike the other research) we took into account the realities of practice," said Liaw. He pointed out that most physicians don't spend 100 percent of their time seeing patients. Rather, physicians often devote some portion of their day to other tasks, such as completing administrative duties, teaching, conducting research or making hospital rounds.
The study authors noted that some researchers have suggested that U.S. policymakers should focus more on the country's physician distribution problem and less on a perceived shortage of physicians.
"Others contend that current primary care scarcities are due to geographic maldistribution, which may not improve even if the supply increases without specific policies regarding training, recruitment and retention," wrote the authors.
"Moving forward, it would be great to have more data about places that have inadequate resources to meet projected increases in utilization," said Liaw, adding that the question then becomes one of distributing physician resources to places that really need them.
Still, the study authors maintain that, whatever distribution problems there may be, the need for additional physicians is real: "Regardless, as insurance expands, use of primary care physicians will change, raising concerns about the adequacy of the current workforce."
For purposes of the study, authors identified primary care physicians as those specializing in family medicine, general practice, general internal medicine, general pediatrics or geriatrics.
Researchers used the 2008 Medical Expenditure Panel Survey (MEPS) -- administered by the Agency for Healthcare Research and Quality -- to determine the number of annual primary care office visits. According to MEPS, Americans made 977 million office visits in 2008. Of those, 462 million visits were to primary care physicians.
Furthermore, researchers found that
- women made more office visits than men,
- older adults saw their primary care physicians more often than younger adults,
- insured individuals made more visits than uninsured individuals, and
- men were more likely to be uninsured than women.
Researchers calculated that in 2008, an estimated 206,369 primary care physicians provided office-based primary care. That's one practicing primary care physician for every 1,475 persons. Primary care physicians averaged 2,237 patient visits each that year.
Additionally, they noted that U.S. Census projections indicated that the U.S. population will increase an estimated 15.2 percent from 2010 to 2025, with the older-than-65 group increasing by about 60 percent. By comparison, the population of Americans under the age of 18 was projected to increase by just 13 percent.
Finally, the authors projected that the total number of office visits to primary care physicians would increase from 462 million in 2008 to 565 million in 2025.
"By 2025, the United States would require nearly 260,687 practicing primary care physicians, an increase of 51,880 from the current workforce," the authors concluded. "Most of this increased need is attributable to gradual population growth and aging.
"In contrast, the increase from insurance expansion will occur more abruptly, with the bulk of the increase expected in 2014 and 2015," they added.
Study authors pointed out that the ACA included several provisions intended to support growth of the U.S. primary care workforce. For instance, the government made a one-time investment of $168 million to help increase the number of medical school graduates entering primary care residency programs.
"This one-time investment is expected to produce 500 additional physicians, so even if these positions were maintained for 10 years, only 5,000 additional primary care physicians would be trained," said the authors.
In addition, $75 million was allocated to train physician assistants and nurse practitioners, and another $11 billion was set aside to invest in community health centers during the next five years.
The ACA also included measures intended to make primary care a more attractive choice to medical students.
Still, the study authors maintain that continued effort is essential: "Capacity building thus requires both immediate and long-term attention to deliver on the ACA's promise of better, more affordable, and more accessible care."
Liaw reiterated that the ultimate goal is to improve patient access to primary care. He added that most researchers and primary care physicians agree that access to care in the primary care setting -- as opposed to the fragmentation of care that can occur when patients seek primary care services at urgent care clinics and emergency rooms -- was key to keeping patients healthy.
Liaw was unwilling to take a firm stand on whether the looming primary care shortage could be averted.
A few checkmarks in the positive column, including increased student interest in family medicine and a stronger effort on the part of policymakers to increase interest in primary care, suggested a brighter future, said Liaw.
"Whether that's enough is unknown. But definitely, the movement is in the right direction," he said.
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