Fewer clinicians entering primary care, data shows

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Fewer clinicians are entering into the primary care field, and investments in primary care are on the downswing, finds a new report from the American Academy of Family Physicians and Milbank Memorial Fund.

According to the findings, years of neglect and chronic underinvestment by the healthcare system have left U.S. primary care in a position where it’s increasingly unable to meet patients’ needs, particularly in rural and other underserved communities.

The combination of worsening primary care access and sicker patients has created a cycle whereby patients use more expensive services like emergency rooms, which raises healthcare costs and premiums, further reducing affordability and access, the report said. And overall healthcare spending continues to rise faster than economic indicators, with the primary care infrastructure only receiving a small fraction of that money.

WHAT’S THE IMPACT

Spending on primary care was under 5% in 2022 and continued its decline across all payers, with primary care spending in Medicare and Medicaid decreasing the most since the last scorecard report, down to 3.4% and 4.3% in 2022, respectively.

Reimbursement rates for primary care physicians are lagging, the report’s authors said. In 2022, primary care physicians’ reimbursement per visit averaged $259, compared to $1,092 for gastroenterology. 

This relative lack of revenue limits practices’ capacity to provide high-quality primary care and hinders the field’s ability to draw in new clinicians, the report found.

Further data highlighted the effects on the workforce. The number of primary care clinicians (PCCs), including physicians, physician associates (PAs) and nurse practitioners (NPs), dropped from 105.7 per 100,000 in 2021 to 103.8 per 100,000 in 2022. The number of primary care physicians (PCPs) per 100,000 population remained flat at around 67, while the number of advanced practice providers per 100,000 population in primary care fell slightly (from 38 in 2021 to 37 in 2022).

The percentage of NPs and PAs in primary care dropped to new lows of 30% and 24.3% in 2022, respectively, compared with 34% and 29.7% in 2021, respectively. More than 30% of U.S. adults lacked a usual source of care (USC) in 2022 — the highest level in a decade, despite historically high rates of insurance coverage during this period. The percentage of children without a USC dropped from 13.6% in 2021 to 12.4% in 2022.

At the same time, there’s a widening disparity in growth in medical residents per capita between primary care and all other specialties. The rate of primary care residents remained stagnant at 17 per capita between 2020 and 2022, while the rate for all other specialties increased from 29 to 30 per capita.

In 2022, the percentage of new physicians entering primary care dropped to 24.4% (or 19.8% when excluding hospitalists), marking its lowest rate in a decade, numbers showed.

THE LARGER TREND

People are shifting away from traditional primary care providers, with about three in 10 forgoing primary care altogether between 2016 and 2022, according to FAIR Health’s 2023 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.

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.

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.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.