- The number of hospitalists has increased nearly 50% between 2010 and 2017, according to a new report by the Medicare Payment Advisory Commission (MedPAC).
- Many primary care physicians (PCPs) are apparently abandoning that specialty in order to become hospitalists, who can expect better pay and more predictable work hours.
- Nevertheless, MedPAC concludes that access to primary care physicians by Medicare enrollees remains adequate — for now.
Hospitalists — physicians typically trained in internal medicine but who only attend to patients while they're in hospitals — began populating the healthcare landscape in the 1990s. But only in the past decade have they really become a significant component of inpatient care.
According to the newly released MedPAC report, the number of hospitalists nationwide grew from 32,427 in 2010 to 48,407 in 2017. During that same period of time, the proportion of internal medicine residents who decided they wanted to become hospitalists grew from 9% to 19%.
This has put a damper on the growth of primary care physicians. According to new data from MedPAC, about one in five physicians it previously considered to be a PCP was actually a hospitalist. As a result, the number of PCPs practicing in 2017 were cut from 186,193 to 140,290, a drop of 25%. Therefore, growth in the number of PCPs was negligible — up less than 5,000 between 2010 and 2017. Their overall numbers actually contracted by 0.6% between 2016 and 2017, according to MedPAC.
Still, the commission does not see the glacial growth in primary care physicians over much of the past decade to be a cause for alarm. According to its surveys of Medicare beneficiaries, the "revised counts of PCPs do not change the conclusion that beneficiary access to care has remained adequate" and that access remains as good or better than the population of privately insured Americans.
According to MedPAC data, the number of encounters between each PCP and Medicare enrollee dropped from 4.1 in 2013 to 3.7 in 2017, a reduction of about 10%. It appears physician assistants and nurse practitioners are picking up the slack. Each Medicare beneficiary had 1.8 encounters with those clinicians in 2017, up from 1.1 in 2013, an increase of more than 60%. Encounters with specialist physicians and other practitioners barely budged during that time.
But that doesn't mean MedPAC is unconcerned about the current trends with PCP growth. It concluded its report noting the "flat or declining trend in PCPs reinforces the Commission's concern about (the) future pipeline."