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Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities. However, there are micro-practice patterns within primary care specialties that are not well understood. To examine the differences among primary care physician practice locations by specialty and race/ethnicity, a retrospective study was conducted on U.S. medical graduates who were direct patient care physicians in 2012. The group-specific contributions to primary care accessibility were decomposed by individual group of minorities underrepresented in medicine (URM). Results confirm significant differences not only in their distribution across underserved areas but also in their racial/ethnic composition by primary care specialties, with internist most diverse and family physicians least diverse. However, stratified analysis shows that within each primary care subspecialty, URM physicians were more likely to practice in underserved areas than their White peers regardless of specific specialties.

Despite efforts to mitigate a projected primary care physician (PCP) shortage required to meet an aging, growing, and increasingly insured population, shortages remain, compounded by the COVID-19 pandemic, growing inequity, and persistent underinvestment. We examined primary care workforce trends over the past decade and revisited projected primary care clinician workforce needs through the year 2040. Using data from the AMA Masterfile and Medical Expenditure Panel Survey (MEPS), we analyzed trends in the number of primary care physicians (PCPs) and in outpatient PCP visits by age and gender over the past decade. We then used the Medicare PECOS and Physician & Other Practitioners datasets to identify nurse practitioners (NPs) and physician assistants (PAs) in primary care. Using these baseline clinician enumerations and projected population growth estimates from the US Census Bureau for the years 2020-2040, we calculated estimated primary care workforce needs by 2040. The effects of aging and population growth and baseline shortages in the primary care workforce call for significant increases in the primary care workforce to accommodate rising demands. Office visits to primary care clinicians are projected to increase from 773,606 in 2020 to 893,098 in 2040. We project a need for an additional 57,559 primary care clinicians by 2040. Workforce shortages in primary care continue to expand due to population aging, growth, and heightened rates of clinician burnout & egress.

Geographic inequities are known to affect access to liver transplant (LT); however, the impact of these disparities postoperatively remains unknown. We focus on primary care physicians (PCPs), as frequent managers of long-term LT recipient care. Clinical data on adults undergoing liver-only transplant 2010–2021 were obtained from the Organ Procurement and Transplantation Network and linked to zip code-based PCP density and social vulnerability index (SVI) data to quantify the impact of PCP density on graft and overall survival. 64,593 patients were divided into quintiles by PCP density. Compared to patients in the lowest PCP quintile, patients in the 3rd, 4th, and 5th quintiles had 6%–8% lower mortality risk (HR3rd ​= ​0.94, HR4th ​= ​0.92, HR5th ​= ​0.94, p for trend ​= ​0.002). PCP density remained significant after accounting for SVI and local surgeon and gastroenterologist availability (p ​= ​0.002). Increased PCP availability is associated with improved survival, emphasizing the importance of establishing longitudinal care. •Liver transplant recipients often transition long-term care to primary care doctors.•Geographic disparities persist in both transplant and primary care access.•Decreased primary care access alone is significantly associated with worse survival.•Establishing longitudinal care in low-primary care areas may improve OS.

Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. The authors analyzed the impact of two emerging models of care -- the patient-centered medical home and the nurse-managed health center -- both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. They found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management. Adapted from the source document.

Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients' ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We used simulation methods to provide estimates of the number of primary care physicians needed, based on a comprehensive analysis considering access, demographics, and changing practice patterns. We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care-including the use of teams or \"pods,\" better information technology and sharing of data, and the use of nonphysicians-have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage. [PUBLICATION ABSTRACT]

Impending physician shortages in the United States will necessitate greater reliance on physician assistants and nurse practitioners, particularly in primary care. But how willing are Americans to accept that change? This study examines provider preferences from patients' perspective, using data from the Association of American Medical Colleges' Consumer Survey.We found that about half of the respondents preferred to have a physician as their primary care provider. However, when presented with scenarios wherein they could see a physician assistant or a nurse practitioner sooner than a physician, most elected to see one of the other health care professionals instead of waiting. Although our findings provide evidence that US consumers are open to the idea of receiving care from physician assistants and nurse practitioners, it is important to consider barriers to more widespread use, such as scope-of-practice regulations. Policy makers should incorporate such evidence into solutions for the physician shortage [PUBLICATION ABSTRACT]

The declining trend in the number of primary care physicians worldwide has led to shortages especially within socioeconomically deprived areas. Socioeconomically deprived areas in the context of this review are defined by regions where there are lower levels of income and access to essential services such as primary healthcare compared to other areas. This shortage contributes to a higher incidence of preventable hospital admissions, unnecessarily straining healthcare infrastructure and negatively affecting patient outcomes. Previous studies have often been limited in scope, focusing on isolated factors or specific regions. Therefore, the objective of this systematic review is to synthesise current research to provide a better understanding of the underlying causes of this high turnover, ultimately informing strategies to address the global shortage of primary care physicians. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Refer to S1 Table for the PRISMA 2020 checklist. A comprehensive search was conducted across PubMed (1970 to September 2024) and Embase (1974 to September 2024). The eligibility criteria included quantitative empirical studies that included a measurement of at least one of the factors behind increased primary care physician turnover or retention within socio-economically deprived or disadvantaged areas. However, the included studies were required to employ a specific methodology for classifying or defining socioeconomic deprivation. The references were screened, the studies selected, the data extracted, and the risk of bias assessed using the ROBINS-I tool, with both reviewers in agreement. Thirteen studies were identified. The factors measured in the studies driving increased turnover in deprived areas included region of work (n = 7), income (n = 2), burnout (n = 2) and social values (n = 2). Some studies found additional challenges specific to socioeconomically deprived areas, such as familial concerns about regional safety, limited employment opportunities for spouses, or personal career development challenges. However, some studies identified increased hours and sickness presenteeism as stronger contributors to burnout. However, this link can be presumed to be stronger in deprived areas due to staffing shortages, though none of the studies in this systematic review have directly measured this correlation. Though longer-term methods of retention within socioeconomically deprived areas included more collaborative working environments and flexible working hours, this can also be applied to benefit healthcare settings across all regions. The studies reviewed have consistently highlighted the repeating cycle of persistent staff shortages contributing to an increased turnover rate within disadvantaged areas internationally. Therefore, implementation of targeted policies by governments and healthcare organisations is required to retain primary care physicians within these areas to ultimately improve and standardise patient care.

Background This study is the first in Taiwan to apply the enhanced two-step floating catchment area (E2SFCA) method to evaluate the spatial accessibility of primary care. Traditional physician-to-population ratios by administrative region overlook cross-boundary healthcare-seeking and travel distance barriers. This study accounts for these limitations and further examines the impact of accessibility on healthcare utilization and outcomes. Methods We used national health insurance claims, physician registry data, and GIS-based road networks to measure accessibility with the E2SFCA method, defining it as the number of primary care physicians per 10,000 residents within a 30-minute travel time. A retrospective cohort of 2 million adults was analyzed. Generalized estimating equations with appropriate regression models assessed associations between accessibility and healthcare utilization, expenditures, avoidable emergency department (ED), and avoidable hospitalizations. Results Spatial analysis identified 15 townships (114,915 residents, 0.49%) with no primary care physicians and another 15 townships (114,430 residents, 0.49%) with low accessibility. These underserved areas were concentrated in central and eastern Taiwan, whereas metropolitan regions had sufficient resources. Higher accessibility was significantly associated with fewer ED visits (ratio = 0.994; 95% CI: 0.990–0.997, P < 0.001), ED expenditures (ratio = 0.993; 95% CI: 0.989–0.997, P < 0.001), the odds of avoidable ED visits (odds ratio = 0.993; 95% CI: 0.988–0.998, P  = 0.005), and the number of avoidable ED visits (ratio = 0.993; 95% CI: 0.988–0.998, P  = 0.004). Accessibility also reduced the odds of avoidable hospitalization (odds ratio = 0.995; 95% CI: 0.990–0.999, P  = 0.017). Conclusion Greater spatial accessibility to primary care was linked to reductions in ED visits, ED costs, avoidable ED use, and avoidable hospitalization. The E2SFCA method provides a more accurate tool for identifying underserved regions and can inform equitable allocation of healthcare resources. Telemedicine and mobile services should be expanded to address shortages in remote areas.

Rural U.S. residents face higher mortality rates and reduced access to primary care physicians. Prior studies report mixed findings on physician supply and health outcomes, and few have examined whether increasing supply reduces rural–urban mortality disparities. The objective was to quantify the marginal benefits of additional primary care physician supply in rural and urban areas, independent of other healthcare and socioeconomic factors. We conducted a 23-year county-level longitudinal observational study of 2942 U.S. counties (1992-2014). Mortality rates were obtained from CDC WONDER, physician supply and socioeconomic characteristics from the Area Health Resource File, and rural–urban classification from the USDA’s 2013 Rural–Urban Continuum Codes. We estimated regressions of age-adjusted mortality rates as a function of physician supply, rurality, and county-level characteristics. Despite the higher per-capita supply of hospital beds and post-acute care services in rural areas, physician supply was lower and grow more slowly than in urban areas. County-level analysis showed a negative association between physician supply and mortality. In rural counties, greater physician supply was associated with lower mortality rate; an increase of 1 physician was associated with 1.4 (CI: −1.963 to −0.836) and 0.936 (CI: −1.411 to −0.462) fewer deaths per 100 k population of older adults in rural counties adjacent and non-adjacent respectively, compared to 0.038 fewer deaths per 100 k population of older adults in urban areas. The declining physicians supply in areas where the number of physicians is already low is an alarming problem for rural communities. Efforts by policymakers to broaden rural health networks and increase rural medical personnel may be needed to address disparities in access to care and associated mortality outcomes. Although the dataset covers 1992 to 2014, the findings remain highly relevant given the continued rural physician shortages and widening mortality disparities that persist across the United States.

Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certain administrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States.Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certain administrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States.