Quantifying the Health Benefits of Primary Care Physician Supply in the United States

Abstract

This analysis addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States? A search of the PubMed database for articles containing "primary care physician supply" or "primary care supply" in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care physicians per 10,000 population. Primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980-1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year. Forecasting the need for physicians is generally based on task and time projections (1) and benchmarking with health maintenance organizations rather than on assessments of the likely contributions to improving health (2). In the 1990s, these approaches predicted physician surpluses in the 2000s. However, recent analyses using macroeconomic projections of demand for health services predict physician deficits of as many as 200,000 by 2025 (3). As a consequence, the Council on Graduate Medical Education reversed its position that the United States is producing too many physicians, and it has now endorsed the view that the nation may, in fact, be producing too few (4). The purpose of this article is to summarize existing studies of the likely effect of primary care physician supply on a variety of health outcomes. It addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States?

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…[4][5][6] Systems (both within the U.S. and internationally) that emphasize the primary care role have lower per capita costs, better health outcomes and lower rates of premature mortality for a range of conditions. [7][8][9][10][11][12][13][14][15][16][17][18][19] However, for a variety of reasons, the practice of primary care has been in decline in the U.S. [20][21][22] Accordingly, a number of policy initiatives are underway to re-invigorate the area of primary care. These may be complicated, however, by diverse perspectives on what constitutes primary care and the evolving delivery system in which the primary care functions occur.…”

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

“…Communities served by primary care physicians (PCPs) are linked to overall improved health. 1,2 Concerns exist, however, about an increasing shortage of adult PCPs to care for an aging population. [3][4][5] Fewer physicians now enter into outpatient primary care, 6 and there is a looming attrition rate of PCPs, with almost one-quarter of practicing PCPs in 2011 being 56 years of age or older.…”

When one door closes, another door opens: Physician availability and motivations to consult complementary and alternative medicine providers

“…[6][7] Yet little is known about the effect of access difficulties on consumers' health-care choices. The unmet health-care needs that result from physician shortages may not only contribute to greater health risks [8][9] , but can have implications for consumers' health-care attitudes, [10][11] choices, and behaviours 12 . This may be especially true in Canada where unmet health-care needs due to physician shortages have risen substantially over the past decade.…”

“…For example, access difficulties have been linked to patient dissatisfaction. [4][5][6][7][8][9][10] Consequently, consumer-minded individuals facing difficulties receiving primary-care may choose to look outside of conventional care to have their health-care needs met.…”