NEW ORLEANS – Supply of primary care physicians is unlikely to meet demand when the Affordable Care Act is fully implemented in 2014 and shortages will be more acute in some regions that others.
Overall, the expansion of health insurance to a wider population is likely to mean that the United States will need an additional 8,000 primary care physicians over what is currently projected, or a 3% increase in the current workforce, by 2025, Stephen M. Petterson, Ph.D., reported at the annual meeting of the North American Primary Care Research Group.
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It is unlikely that there will be enough primary care physicians to meet the demand necessitated by 2014’s Affordable Care Act implementation.
While that may not seem to be a huge increase, the nation will need 43,000 additional primary care doctors just to keep pace with population growth and the aging of that population.
Taking into account population growth, the aging of the population, and the impact of the ACA, the number of office visits in the United States will increase from 462 million in 2008 to 565 million in 2025 (Ann. Fam. Med. 2012;10:503-9). Dr. Petterson and his colleagues noted that their analysis is the first look at the ACA’s impact specifically on the primary care workforce and primary care services.
To get at that data, the authors used the Medical Expenditure Panel Survey (MEPS) to calculate the use of office-based primary care in 2008, U.S. Census Bureau projections for population estimates, and the American Medical Association Masterfile to calculate the number of primary care physicians and determine the number of visits per physician.
They determined that 46% of all physician office visits are to primary care physicians. MEPS data show that in 2008, there were 977 million office visits to physicians, 462 million of which were to primary care physicians. Women made more office visits than did men, older adults more than younger ones, and the insured more than the uninsured.
Previous studies have shown that when people gain insurance coverage, they tend to use more services, said Dr. Petterson, research director at the Robert Graham Center, a primary care think tank in Washington, D.C.
Based on their analysis, by 2025, an estimated 260,687 practicing primary care physicians will be needed – an increase of 51,880 from today. Most of the additional workforce can be built gradually, to accommodate aging and population growth, they said. But there will be a more urgent need in 2014 and 2015 when the ACA is fully implemented and there will be an additional 20 million primary care visits.
The ACA proposes to build the primary care workforce through expanding the number of primary care residents and increasing training for physician assistants and nurse practitioners. But that will only produce an estimated 500 additional physicians, said the authors, noting that "even if these positions were maintained for 10 years, only 5,000 additional primary care physicians would be trained."
The need for more primary care doctors varies geographically, Dr. Petterson said at the meeting.
Some states, those with a low number of uninsured, small populations, or a relatively high concentration of physicians, won’t need to bump up their numbers by much. Those states include Vermont, North Dakota, Wyoming, Delaware, the District of Columbia, South Dakota, Hawaii, Rhode Island, New Hampshire, and Montana.
The 10 states that will require the largest increase in the workforce are New Jersey, Pennsylvania, Ohio, North Carolina, Georgia, Illinois, New York, Florida, Texas, and California. These states have a high number of uninsured patients and a relatively low ratio of primary care physicians to the overall population, Dr. Petterson said. On the low end, New Jersey will need to increase its workforce by about 3%, or 200 or so new physicians. Texas and California are looking at a 7% and a 5% increase respectively, he said.
"The sudden influx of newly insured patients will exacerbate this situation," he said.
The authors had no relevant conflicts of interest; the study was funded in part by the Agency for Healthcare Research and Quality.