Why finding a primary care provider can be so tough
The number of primary care physicians (PCPs) seeing new patients in the U.S. is declining and the number of advanced practice providers (APPs)—including physician assistants and nurse practitioners—available for these visits isn’t enough to fill the gap, according to a new study from researchers at Harvard T.H. Chan School of Public Health.
The study was published Jan. 20 as a research letter in JAMA Internal Medicine. Harvard Chan co-authors included first author Kate Majzoub Morgan, a candidate in the MPH in Clinical Effectiveness program and an internal medicine physician at Brigham and Women’s Hospital (BWH); postdoctoral research fellow René Karadakic; and Michael Barnett, former associate professor of health policy and management.
Morgan was interviewed about the study findings in a JN Learning podcast, along with Ishani Ganguli, a primary care physician at BWH and associate editor at JAMA Internal Medicine, who co-authored an editorial accompanying the new study.
Even though there are a high number of physicians in the Boston area, Morgan said that she and colleagues had increasingly been hearing from people who couldn’t find a PCP. She noted that it’s well-documented that the number of practicing PCPs in the U.S. is declining. But some recent studies suggest there are other factors at play, such as PCPs seeing fewer patients for ongoing care and cutting back on their work hours.
To explore PCP availability, Morgan and colleagues decided to look specifically at new patient visits, “thinking that in the real world, when somebody needs a primary care physician … really what matters is how many clinicians are accepting new patients,” Morgan explained.
They examined fee-for-service Medicare claims data between 2013 and 2021 to learn how the number of clinicians available to see new patients and the number of new patient visits provided changed over time. They also looked at how PCPs versus APPs were contributing to these new visits.
The researchers found a persistent decline in the number of PCPs accepting new patients. In 2013, there were 75,140 PCPs available for new visits; by 2021, the number had dropped to 56,438—a 23% decrease. “That’s enormous,” Morgan said. Fewer than half of all PCPs in the U.S. were available for new visits in 2021, according to the researchers.
During the same time period, the number of APPs available for new visits rose from 12,768 to 24,432—a 91% jump—but because there were fewer APPs to begin with, that increase didn’t offset the decline in PCPs. Overall, Morgan said, there was a 5% decrease in the number of clinicians available for new visits.
“Based on our study, it’s very clear that APPs have become a core part of the primary care workforce,” Morgan said. “And the solution is going to depend on how well we can design our systems to make the most of the APP workforce and the physician workforce and really thinking thoughtfully about what each profession has to bring to primary care.”
Listen to the JN Learning podcast: Primary Care Clinicians Available for New Patient Visits
