Having more primary care physicians in an area leads to better mortality outcomes and a lack of PCPs may also hurt population health programs, according to a new study in JAMA Internal Medicine.
Overall PCP supply increased from 196,014 physicians in 2005 to 204,319 in 2015, but the areas with more doctors weren't necessarily those with the greatest needs by population. Rural areas had larger losses per population than other regions, which could restrict access to care in and hurt population health.
The researchers found that adding 10 PCPs per 100,000 people was connected to a 41.5-day increase in life expectancy, while an increase of 10 specialists per 100,000 people led to a 19.2-day increase. More PCPs also lead to reduced cardiovascular, cancer and respiratory mortality.
The report confirmed the belief that more PCPs result in better health for a region. The researchers included control variables, such as specialist supply, as well as healthcare, socioeconomic, environmental and demographic features.
In an invited commentary about the topic in the same journal, Sondra Zabar, Andrew Wallach and Adina Kalet of the New York University School fo Medicine wrote that the study findings are consistent with other results. They called for payment reform as a way to help improve PCP numbers, especially in underserved and rural areas. Providing better payments for PCPs may attract more medical students into primary care. It could especially help underserved areas that new doctors often avoid.
"Our reimbursement system needs to incentivize a realignment in the ratio between primary care and non-primary care that is associated with the best population health, such that primary care physicians no longer shoulder a disproportionate share of administrative work, such as medical refills and prior authorizations," the commentary authors said.
Top-notch primary care training isn't enough to lure more doctors into primary care. Without improved payments, population health will suffer. "The cost of inaction will be increased morbidity and higher premature mortality in the U.S. population," they added.
Recent studies have tackled the issue of PCP shortages. UnitedHealth Group found that 13% of Americans live in an area with a primary care shortage. The Association of American Medical Colleges expects a primary care shortfall of between 14,800 and 49,000 by 2030.
The new JAMA Internal Medicine report comes less than a month after a different study in the journal also raised the alarm about the importance of primary care. That report found that limits to value-based investment are preventing primary care's potential.
Beyond the public health importance of primary care, a recent Premier analysis found there's a bottom line impact for hospitals. More PCPs could help patients better control chronic conditions, resulting in fewer emergency department visits.
Another issue for primary care is that fewer people are visiting PCPs. The Health Care Cost Institute recently said that people with employer-sponsored health insurance had an 18% decrease in PCP visits between 2012 and 2016. Instead, more patients are visiting nurse practitioners and physician assistants, which are expected to play major roles in alleviating predicted primary care shortages.