The U.S. Primary Care Physician Workforce: Minimal Growth 1980-1999

One Pagers | Oct 15, 2003
Holly Biola, MD; Larry Green, PhD; Robert Phillips, MD, MSPH; Janelle Guirguis-Blake, MD; ED Fryer, PhD

Growth in the primary care physician workforce (physicians per capita) in the United States has trailed the growth of the specialist physician population in recent years. This has occurred despite calls during the same period for increased production of primary care physicians and educational reforms focusing on primary care.

Physicians' offices remain the most likely place Americans receive formal health care in the United States. The number of physicians per capita who classified themselves as "office-based" increased by 53 percent between 1980 and 1999, resulting in 428,923 office-based physicians or 1.57 per 1,000 people.

As shown below, only a modest success was achieved between 1980 and 1989 in increasing the number of primary care physicians per capita (family physicians +0.3 percent, general internists +8.0 percent, and general pediatricians +7.5 percent) while the production of other physician specialists was much greater (+41.0 percent). Specialists accounted for more than three fourths of the growth in the physician (per capita) workforce from 1980 to 1999, despite concerted widely publicized, policy and funding efforts to increase the number of primary care physicians.

Note: Office-based physicians include all MDs and DOs who reported 80% or more of their work in the office setting. DOs were estimated using National Ambulatory Medical Care Survey, Area Resource Files, and American Osteopathic Association data. Population for each time period was based on US Census.

There was no great resurgence of primary care physicians in the United States at the end of the 20th century. Instead, the period from 1980 through 1999 continued a relentless, relatively rapid expansion of the subspecialized physician workforce. This is not good news for the development of a balanced physician workforce thought to be necessary for effective, sustainable healthcare. Fresh strategies are needed to develop and sustain primary care physicians.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Published in American Family Physician, Oct 15, 2003. Am Fam Physician. 2003;68(8):1483. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.