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    Population growth a primary driver of the need for another 52,000 PCPs by 2025

    Primary care office visits are projected to increase by about 22% by 2025, requiring the help of another 52,000 primary care physicians (PCPs), according to a new study published in the Annals of Family Medicine.

    The increased need for PCPs primarily will be driven by population growth, according to the report, but the expansion in the number of insured Americans after the Affordable Care Act (ACA) is fully implemented also will be a factor.

    Study authors estimate that population growth will create a need for 33,000 additional PCPs, and 10,000 more will be needed to accommodate population aging. The expansion of insured individuals from the ACA is expected to create a need for roughly 8,000 more PCPs, the study notes.

    In 2008, the Association of American Medical Colleges predicted a shortage of about 46,000 full-time equivalent PCPs by 2025.

    Americans made 462 million office visits to PCPs in 2008. That is almost half of the total physician visits for that year, according to the study, and represents roughly 1.6 PCP visits per person each year. According to data from the American Medical Association’s Master File, almost 250,000 PCPs were in direct patient care in 2010. Adjusted to account for PCPs working in emergency departments and urgent cares, the study authors estimate about 209,000 PCPs provided office-based care that year. Assuming the number of PCPs had increased since 2008, the study estimated that a little more than 206,000 office-based PCPs were practicing in 2008. Assuming those PCPs handled the 462 million office visits in 2008, which accounts for 2,237 visits per PCP that year—resulting in one PCP for every 1,475 Americans.

    Census projections show a population increase of 15.2% from 2010 to 2025, with the population of those aged 65 or more increasing by 60% and those aged fewer than 18 years increasing by 13%. The study concluded the increase in office visits from 462 million in 2008 to 565 million in 2025 using these figures. Assuming the average number of office visits annually per PCP, study authors project a need for 260,687 PCPs by 2025—an increase of 51,880 PCPs above the current workforce. Population growth and aging add the largest need to the figure over time, whereas an increased need from insurance expansion under the ACA will happen more abruptly in 2014 and 2015.

    Study authors also discuss how to meet this need.

    In 2010, the Health Resources and Services Administration distributed almost $250 million to try to increase the number of primary care clinicians. Yet the study estimates those efforts will only result in the training of about 5,000 more PCPs. More will have to be done, considering the number of internal medicine residents choosing primary care is dropping.

    “The ACA included provisions to increase the attractiveness of primary care. Proposed increases for [PCP] reimbursement from Medicare and Medicaid, emphasis on Patient-Centered Medical Homes, and outlines for a national primary care extension service, if funded and implemented, would help support a satisfied and productive primary care physician workforce,” study authors note.

    But policymakers also need to consider distribution problems, the study concludes.

    “Our estimates do not account for the uneven distribution of services whereby some areas experience pervasive shortages,” study authors note. “The newly insured will only exacerbate this maldistribution if they cluster in physician-scarce areas. Policy options that increase the size of the primary care workforce without addressing distribution will be less successful. More funding for programs such as the . National Health Service Corps has the potential to reverse this inequity.”

    The study concludes that more research is needed to understand how to best meet the growing need for PCPs, noting that increased productivity by existing PCPs will not be enough to solve distribution problems and a lack of newly trained doctors willing to enter primary care practice. Without a better solution to the current path for meeting the shortage, universal healthcare will not be possible because the workforce will not be prepared to serve the needs of the population, the study concludes.

    The study was funded in part of the Agency for Healthcare Research and Quality , and was conducted by researchers at the Robert Graham Center , Virginia Commonwealth University, Georgetown University and the Agency for Healthcare Research and Quality.

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    Go back to current issue of eConsult.

    Rachael Zimlich
    Rachael is an Associate Editor who also contributes to MHE sister publications


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