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US needs 52 000 more primary care doctors by 2025, new study says

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8259 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8259
  1. Janice Hopkins Tanne
  1. 1New York

The United States will need nearly 52 000 more primary care doctors by 2025, estimates a new study that looked at numbers of patients’ visits to their doctors.

Population growth will be the largest factor driving the need for more primary care doctors, accounting for about 33 000 more, says the study, published in the Annals of Family Medicine.1

An additional 10 000 primary care doctors would be needed to care for the aging population and about 8000 more for the roughly 34 million people newly insured as a result of the Affordable Care Act.

The study used the 2008 medical expenditure panel survey administered by the Agency for Healthcare Research and Quality. This national dataset had not been used before to estimate physician workforce needs, said the study’s lead author, Winston Liaw, of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, DC, and the Department of Family Medicine at Virginia Commonwealth University in Fairfax, Virginia.

“The [panel survey] queries individuals about healthcare access,” Liaw told the BMJ. The paper also includes an estimate of the increase in visits resulting from the Affordable Care Act, which are likely to increase sharply in 2014 and 2015.

Using the survey data Liaw and his colleagues calculated the mean number of visits to a general practitioner, family physician, pediatrician, geriatrician, or general internist. It did not include visits to obstetricians and gynecologists, whom many women use as their primary care doctor, because it proved difficult to determine which of these specialists do only primary care.

In 2008 nearly half of people residing in the United States who saw a doctor went to a primary care physician. Patients made a mean of 1.6 visits to a primary care doctor each year. Women, older adults, and people with health insurance made more visits.

The average number of visits would rise to 1.66 a year by 2025, the researchers say—a 3.8% increase.

Using data from the American Medical Association’s “masterfile” of physicians, the survey estimated that there were 206 369 doctors in primary care in 2008, about one for every 1475 people. “The ratio of primary care physicians to specialists in the United States is about 30% to 70%,” Liaw said, but in other industrialized countries the ratio was closer to 50:50.

Incentives were needed to encourage internal medicine residents to go into primary care. Among such incentives, Liaw said, are increased payments from Medicare and Medicaid and the medical home approach, where the doctor delegates some tasks to team members, thus providing more time for doctors to concentrate on complex cases.

A poor distribution of doctors to rural and underserved areas remained a problem, said Liaw, and incentives were needed to get doctors to practice in such areas.

Notes

Cite this as: BMJ 2012;345:e8259

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