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Supply of primary care physicians remained same or worsened from 2010 to 2019, despite billions

When the comprehensive health care reform bill known as the Affordable Care Act came into effect in 2010, it sought to remove the barriers that prevented many Americans from accessing health care—primarily by making health insurance available to more people to make. But a lack of doctors, especially general practitioners, remains a major barrier to health care in many communities with high poverty rates. As such, in 2011 the federal government invested more than $11 billion to expand the PCP workforce in medically underserved communities.

  • by JACQUELINE MITCHELL | Beth Israel Deaconess

In a paper published in JAMAresearchers from Harvard Medical School and Beth Israel Deaconess Medical Center used national data to study how the supply of primary care physicians in the United States has changed over the past decade due to key county-level characteristics, including concentration of racial and ethnic minorities, poverty , rurality and geography. The team found that despite recent federal investment, the supply of PCPs has not changed significantly in counties with high poverty rates and those with the highest concentration of racial and ethnic minorities.

“In fact, the number of primary care physicians per 100,000 population has declined in rural and southern counties,” senior author said. Rishi Wadhera, HMS assistant professor of medicine at Beth Israel Deaconess. “These findings are of great concern because PCP supply is associated with population-level health and mortality. PCP shortages, in turn, may contribute to inequality in health care access and outcomes in the United States.

Wadhera, also head of health policy and justice research at the Smith Center for Outcomes Research in Cardiology, and first author Michael Liu, a statistician programmer at the HMS Department of Health Care Policy, collected data on the number of PCPs under age 75 in all 3,142 US counties and the demographics of those counties. Next, the team focused on counties with the highest percentages of black and Hispanic individuals, counties with the lowest incomes, and rural counties and calculated the county-level annual supply of primary care physicians per 100,000 people over the past decade.

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Analyzes showed that the number of PCPs per capita did not change between 2010 and 2019 in the top 10 percent of counties with the highest percentage of minorities compared to the remaining counties. The disparities between the two groups persisted throughout the study period. Similarly, there was no change in the supply of PCPs in counties with high poverty levels, and the differences between counties with the highest poverty levels and those with the lowest poverty levels remained unchanged over the study period.

Concerningly, the number of PCPs decreased in rural counties during the study period, but remained stable in urban counties, resulting in a significantly widening rural-urban divide. Southern counties also consistently had the lowest PCP supply per 100,000 residents and experienced significant declines between 2010 and 2019, while no changes were observed in other geographic regions.

The authors note that these data reflect a worrying physician shortage that was evident before COVID-19, and suggest that the pandemic has only exacerbated the problem.

“The COVID-19 pandemic has certainly exacerbated the PCP deficit crisis and likely further exacerbated inequalities in underserved communities,” said Wadhera. “Emerging data shows an exodus of healthcare workers, including primary care physicians, in the US, and there are concerns about the long-term impact of the pandemic on physician workforce diversity.”

“We hope our findings help to spur further action from health system leaders and policymakers,” said Liu. “Current policies, including funding allocated to support primary care staff in these communities, are likely necessary, but not sufficient, to achieve this goal. Other evidence-based interventions should be considered to help recruit and retain PCPs in underserved communities, such as alleviating education debt, recruiting more students from underrepresented backgrounds, and increasing opportunities for students to train in underserved communities such as rural provinces.

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This work was funded in part by the National Heart, Lung and Blood Institute (grants R01HL164561 and K23HL148525).

Wadhera reported receiving personal benefits from CVS Health and Abbott. No other revelations were reported.

Adapted from a Beth Israel Deaconess press release.

/Public release. This material from the original organization/author(s) may be timed, edited for clarity, style and length. Views and opinions expressed are those of the author(s). View in full here.

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