13% of People Live in an Area with a Primary Care Physician Shortage

September 17, 2018 - Approximately 13 percent of US residents, or 44 million individuals, live in a county with a primary care physician shortage, according to new data from UnitedHealth Group.

The primary care physician shortage impacts all types of communities, from rural to suburban, the healthcare and well-being company led by the payer United Healthcare found.

Rural residents are about five times as likely to live in a county with less than one primary care physician per 2,000 people compared to urban or suburban residents (38 percent versus 8 percent).

However, nearly as many urban and suburban residents live in a county with a primary care physician shortage as individuals in rural areas, the data showed.

With the primary care physician shortage impacting all regions, the healthcare industry may have to rely more on nurse practitioners (NPs) and other advanced practice clinicians to fill in the primary care gaps, UnitedHealth Group stated.

READ MORE: How Physician Shortages Are Transforming Healthcare’s Future

“Allowing NPs to practice to the full extent of their education and training represents a meaningful, timely opportunity to increase primary care capacity in the US,” the company wrote. “NPs are qualified to independently deliver high-quality primary care and already do so in 22 States.”

NPs and other advanced practice clinicians can meet the increasing demand for primary care services as the supply of primary care physicians dwindles.

The demand for primary care is slated to significantly increase as the population grows and becomes older and less healthy. By 2030, the population will increase eight percent, data from the US Census Bureau revealed.

Simultaneously, the number of individuals aged 65 years or older will rise 38 percent, and the number of individuals aged 75 years or older will rise 55 percent.

Individuals 65 years or older tend to be less healthy compared to their young counterparts. The number of people in that age bracket living with at least one chronic condition will increase by over one-third, UnitedHealth Group found.

READ MORE: Addressing Productivity, Labor to Bend the Healthcare Cost Curve

The US population will demand more primary care services as it ages and becomes less healthy. But physicians are not specializing in primary care, UnitedHealth Group data uncovered.

Only 33 percent of active physicians currently practice primary care, and the number of primary care doctors is only slated to increase by six percent by 2025.

Medical school students are less interested in pursuing primary care. In 2017, only one in six graduates (5,000 out of 30,000 graduates) chose a primary care residency program.

As the population ages, a significant portion of physicians will also retire, creating a greater need for primary care doctors. Over one-third of all physicians currently practicing will be 65 years or older by 2030.

With medical school graduates shying away from primary care and practicing doctors getting ready to retire, the estimated primary care shortage is slated to grow from 18,000 doctors in 2018 to 49,000 by 2030, a cited 2018 analysis by Tim Dall and colleagues showed.

READ MORE: How Adding Physician Assistants Improves Hospital Revenue Cycle

Nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs), however, represent a growing portion of the country’s primary care workforce, UnitedHealth Group found.

Approximately 78 percent of NPs and 28 percent of PAs practice primary care compared to just 33 percent of physicians. Another 12,000 CNMs also practice primary care.

The number of advanced practice clinicians in primary care is also slated to grow. The number of NPs practicing primary care should increase 47 percent by 2025, while the number of PAs and CNMs in the primary care field should increase 39 percent and 17 percent, respectively.

NPs, PAs, and other advanced practice clinicians can fill the primary care gap by delivering care comparable to that provided by physicians.

A recent American Journal of Medicine study found that diabetes management care delivered by NPs and PAs at the Veterans Health Administration from 2008 to 2012 was comparable to the care provided by physicians.

“From a health quality and policy standpoint, our results demonstrate that independently practicing nurse practitioners and physician assistants, within a highly integrated healthcare system, are able to perform as well as physicians in the management of diabetes at diagnosis and during four years of follow-up care,” researchers wrote.

Another recent analysis in Health Education Research also found that non-physician staff also helped hospitals reduce expensive hospital readmissions and prevented value-based penalties in rural hospitals.

However, advanced practice clinicians face restrictive scope of practice laws that could impede their ability to fill in the primary care physician shortage, UnitedHealth Group stated.

If all states allowed NPs to practice to the full extent of their education, advanced clinical training, and national certification, then the number of residents living in a county with a primary care shortage would fall 70 percent, the healthcare company found.

The number of rural residents living in a primary care shortage county would also decline 65 percent.

Relaxing scope of practice laws for advanced practice clinicians would help to address the physician shortage and healthcare cost problem, the Hamilton Project also recently argued.

The economic policy center pushed for states to eliminate supervisory requirements, formal collaborative practice agreements, and advanced practice clinician to physician ratios. States should also permit advanced practice registered nurses to prescribe drugs, the center advised.

“When a physician and a nonphysician practitioner are both qualified to perform certain procedures, each should specialize in the service in which they are most productive—that is, the service in which they have a comparative advantage,” the center stated. “By doing so, the overall efficiency in the system can be improved and costs lowered.”

In addition to relaxing scope of practice laws, the UnitedHealth Group also called on the healthcare industry to consider urgent care centers, retail health clinics, and in-home clinical visits as means to full the primary care physician shortage.