With provider shortage, fewer patients pursue primary care
The nation has been experiencing a primary care shortage since the early 2000s, with declining access affecting many Americans.
Photo: filadendron/Getty Images
People are shifting away from traditional primary care providers, with about three in 10 foregoing primary care altogether between 2016 and 2022, according to FAIR Health's new analysis of private claims data.
That number, though, ranged from a high of 43% in Tennessee to a low of 16% in Massachusetts, suggesting significant regional variations. Of the providers who performed primary care services in that time, 56% were physicians, while 44% were nonphysicians.
The core-based statistical area (CBSA) with the lowest number of people per primary care provider in 2022 was Rochester, Minnesota, with a ratio of 114.5, when measured by the provider's primary practice location. The CBSA with the highest number of people per primary care provider was Zapata, Texas, with a ratio of 2,759.6, again when measured by the provider's primary practice location. The ratio of population to primary care provider, however, differed if the calculated based on the location where patients received care.
Nurse practitioners constituted the largest share of primary care providers by specialty (27%), followed by family medicine physicians (20%), internal medicine physicians (18%) and physician assistants (15%). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others.
The five states with the highest percentage of primary care patients receiving care from a nurse practitioner were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice. And the five states with the highest percentage receiving care from a family medicine physician were more likely to be rural.
During the six-year period, nonphysicians treated greater percentages of patients with diagnoses related to mental health or acute respiratory diseases and infections than physicians did. The percentage of patients with a primary mental health diagnosis treated by a primary care provider increased 7%, while the percentage of patients with a primary substance use diagnosis decreased 2.5%. Primary care nonphysicians saw increases in patients with both behavioral health diagnoses of more than 100% during the same period.
WHAT'S THE IMPACT
According to FAIR Health, a nonprofit company that provides information on healthcare costs and insurance, the nation has been experiencing a primary care shortage since the early 2000s, with declining access affecting many Americans.
The analysis pointed to evidence showing that primary care improves health regardless of age, sex, race, ethnicity, education, employment, income, health insurance and smoking status. It has also been reported that a gain of 10 additional primary care physicians per 100,000 people is associated with an increase in life expectancy by 51.5 days.
But the primary care shortage is pervasive. From 2002 to 2015, the proportion of adult Americans with an identified source of primary care decreased from 77 to 75%, a decline that affected patients in every decade of life except those in their 80s, though the biggest drops were found in patients in their 30s, 40s and 50s, according to a study in JAMA Internal Medicine.
As the shortage continues to worsen, experts predict that rural areas will be more severely affected than suburban or urban areas, while marginalized and low-income populations will also be heavily affected.
THE LARGER TREND
People are increasingly turning to telehealth for their primary care needs. At 94%, the vast majority of patients are satisfied with their experience pursuing virtual primary care, and nearly four in five (79%) say it has allowed them to take charge of their health, according to a November 2022 survey released by Elevance Health.
Insurers are taking note of virtual primary care's growing popularity. In 2021, when Elevance was still known as Anthem, it debuted Aetna Virtual Primary Care through CVS Health. The company said at the time the program would make it easier for people to get the healthcare services they need.
Then, in September 2022, Blue Cross Blue Shield of Massachusetts said it would introduce a new virtual primary care option called the "Virtual Care Team Feature," which enables members to receive comprehensive virtual healthcare through a team that includes dedicated primary care providers.
These providers can treat certain mental health issues and provide health coaching from two national healthcare providers, Carbon Health and Firefly Health, said BCBS.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
