Rural US needs more primary care doctors

For better healthcare, the U.S. needs more primary care physicians. In a study of U.S. population data, greater PCP supply was associated with improved mortality rates, but per capita PCP supply decreased between 2005 and 2015, according to a new study published in JAMA Internal Medicine.

“Many believe that a well-functioning healthcare system requires a solid foundation of primary care,” wrote lead author Sanjay Basu, MD, PhD, of Stanford University, and colleagues. “However, persistent payment disparities between primary care and procedural specialties continue to erode the U.S. primary care physician workforce.”

PCPs are undoubtedly important, as studies have shown primary care follow-up within seven days of a hospitalization is associated with fewer Medicaid readmissions. Additionally, primary care visits can reduce healthcare costs. Despite the known importance of PCPs, healthcare preferences of the younger generations have changed. A recent consumer survey from Accenture showed younger consumers are less likely to have a PCP, compared to older generations. 

Basu and colleagues sought to identify PCP supply changes across US counties from 2005 to 2015 and assess the associations between such changes and population mortality. The researchers used data from more than 3,100 US counties, 7,144 primary care service areas and 306 hospital referral regions.

They noted PCP supply increased from 196,014 physicians in 2005 to 204,419 in 2015. Because of disproportionate losses of PCPs in some counties and population increases, the density of PCPs decreased from 46.6 to 41.4 per 100,000 people—and the impact was more prevalent in rural communities. 

Additionally, the researchers found that for every 10 additional PCPs per 100,000 people, there was a 51.5-day increase in life expectancy. By comparison, an increase in 10 specialist physicians per 100,000 people corresponded to a 19.2-day increase. They also found a total of 10 additional PCPs per 100,000 people was associated with a decrease in cardiovascular, cancer and respiratory mortality, of 0.9 percent to 1.4 percent. 

“Programs to explicitly direct more resources to primary care physician supply may be important for population health,” Basu et al. wrote.

Programs like CMS’ Comprehensive Primary Care initiative, do invest more resources in primary care. Additionally, some states, such as Rhode Island and Oregon, have “substantially increased” primary care spending. But it’s unclear if these initiatives will encourage more medical students to pursue primary care. 

Future studies should assess the effective access of primary care, the researchers noted, rather than just supply. Additionally, studies should explore the dynamics of teamwork across PCPs and specialists in various payment models to address how team-based approaches impact mortality rates and other patient outcomes.