AHRQ Fact Sheets Shed Light on Primary Care Physician, Nurse Practitioner and Physician Assistant Workforce 

FOR IMMEDIATE RELEASE: Thursday, Nov. 10, 2011

Contact: Leslie Champlin
American Academy of Family Physicians
(800) 274-2237, ext. 5224
lchampli@aafp.org

LEAWOOD, Kan. — Although more than half of all patient visits to doctors are to family physicians, general internists, general pediatricians, and geriatricians, these primary care specialties comprise less than one-third of all U.S. doctors.

Those findings — results of research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care — “shine a light on the imbalance between patients’ needs for access to primary care physicians and the supply of those medical specialties,” said Robert Phillips, MD, director of the Robert Graham Center. The numbers were published this week by the Agency for Healthcare Research and Quality (AHRQ) as part of an ongoing series of its “Primary Care Workforce Facts and Stats.”

“Taken together, these data sheets give us important insights into the primary care workforce as a whole and the mix of patient care professionals,” said David Meyers, MD, director of AHRQ’s Center for Primary Care, Prevention, and Clinical Partnerships (CP3), which commissioned this work. “AHRQ believes that revitalizing our nation’s primary care system is foundational to achieving high-quality, accessible, efficient health care for all Americans. The information provided in these briefs will empower health care decision makers as they make critical decisions about how to do this.”

This estimate of the primary care clinician workforce is state-of-the-art in terms of accounting for physicians leaving the workforce and nurse practitioners (NPs) and physician assistants (PAs) leaving primary care. Primary care is a shrinking proportion of all three professions, according to Phillips.

While these figures don’t point to a severe shortage currently, upcoming one-pagers in this series will demonstrate that there is a concerning maldistribution of clinicians that will make providing access to care for newly insured patients in 2014 very difficult. They will also demonstrate a future shortage. The American Academy of Family Physicians (AAFP) predicts a shortage of nearly 40,000 family physicians by 2020, and other research anticipates a shortage of between 35,000 and 44,000 primary care physicians by 2025.

According to “The Number of Practicing Primary Care Physicians in the U.S.,” approximately 209,000 U.S. physicians provide primary medical care. That number includes 87,650 family physicians, 93,655 general internists, 49,642 general pediatricians, and 3,260 geriatricians. These estimates are lower than usually reported and draw on recent studies of physician retirement and historical patterns of how recent graduates enter the primary care workforce or subspecialize. These methods were developed in conjunction with all three federal agencies that monitor physician workforce.

A second AHRQ fact sheet, “The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the United States,” complements the physician data. That data sheet, also aggregated by the Robert Graham Center, found 52 percent of nurse practitioners and 43 percent of physician assistants practiced primary care. The estimate for nurse practitioners is lower than is typically reported, but higher than recently reported by the Health Resources and Services Administration.

“The rapidly declining proportion of NPs and PAs from primary care is concerning. It suggests that all three professions are leaving primary care and that we cannot avoid the hard work of fixing the problems that plague this important workforce and threaten access to effective health care,” said Phillips.

At the same time, the data can help policy makers determine what health reforms can capitalize on the primary care workforce in a way that improves outcomes and helps constrain costs, according to Phillips. Among those reforms is the patient-centered medical home, in which teams of physicians, nurse practitioners, and others work together to meet patients’ needs and coordinate care among team members.

“Studies of patient-centered medical homes have shown that team-based care comprising primary care physicians, nurse practitioners, and physician assistants result in better outcomes, greater patient satisfaction, and lower cost,” said Phillips. “As this concept grows, we can turn to these data to determine how much we need to grow our primary care workforce.”