People with employer-sponsored health insurance are visiting primary care physicians (PCPs) less, but are more commonly seeing nurse practitioners and physician assistants than earlier this decade, according to a new Health Care Cost Institute report.
The Health Care Cost and Utilization Report revealed an 18% decrease in PCP office visits between 2012 and 2016.
There was a 14% increase in office visits for all providers, which shows that patients are going to other providers than PCPs for their care.
NPs and PAs have recently taken on a larger role in primary care. Health experts say those roles will help fill primary care gaps in the coming years with physician shortages expected.
A recent UnitedHealth Group report found that 13% of Americans live in a county with a PCP shortage. That problem is more common in rural areas. It's expected to get worse in the coming decades, especially since only one in six medical school graduates picked a primary care residency program last year.
NPs and PAs are seen as part of a solution, but differing state regulations can present hurdles. At the moment, 22 states give NPs full authority to practice primary care independently, while 16 states allow limited practice authority and 12 states require onsite physician supervision.
HCI said its research showed state laws influenced geographic variation in office visits.
The report found that 51% of office visits for employer-sponsored insurance were for PCPs in 2012. Four years later, that percentage dropped to 43%. Every state saw a drop in PCP office visits between 2012 and 2016, ranging from a 6% decrease in Washington, D.C. to a 31% drop in North Dakota.
On the other hand, NP and PA office visits increased in every state — ranging from a 37% increase in New Mexico to a 285% jump in Massachusetts. Overall, office visits to NPs and PAs skyrocketed 129% between 2012 and 2016. Office visits to specialists and other non-physician providers remained similar between 2012 and 2016.
"Many factors likely influenced the trends described in this brief, including state policies, variation in insurance benefit design and changes in access to different types of providers," according to the report.
The report didn't explore how age or demographics may influence the trend. Patients, especially younger ones, often want convenience and don't feel as connected to a specific PCP. Those patients are more likely to get care beyond a usual doctor's office visit.
Care through NAs and PAs might be thought of as a lower-cost solution to PCPs, but HCI found similar costs for office visits. PCP office visit costs were $106 in 2016 and $103 for NPs and PAs. So, while those visits may offer greater care access and more convenience, they might not provide lower-cost care.