Proportional Erosion of the Primary Care Physician Workforce Has Continued Since 2010

One Pagers | Aug 15, 2019 Andrew Bazemore, MD, MPH; Elizabeth Wilkinson, BA; Stephen Petterson, PhD; and Larry A. Green, MD

We estimate that 217,208 primary care physicians provided direct patient care in the United States in 2018. This represents an even lower percentage (30%) of the total U.S. physician cohort than the 2010 Council on Graduate Medical Education’s (COGME’s) recommendation to increase primary care to 40% of the overall physician workforce.

In 2010, the congressional advisory group COGME declared in its 20th report that “policies supporting physicians providing primary care should be implemented that raise the percentage of primary care physicians (general internists, general pediatricians, and family physicians) among all physicians to at least 40 percent from the current level of 32 percent, a percentage that is actively declining at the present time.”1 We used data from the 2018 American Medical Association Masterfile and the same methods of calculation as COGME to assess progress toward the recommendation, using an established method to account for hospitalists—physicians with primary care specialty training working primarily in hospitals (more than 90% of claims2; Table 1 and Table 2). We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3

Family physicians are the largest contributor to the primary care physician workforce, making up 40% of all primary care physicians, followed by general internists and general pediatricians. With 40% of U.S. family physicians being older than 55 years,4 and substantial proportions of primary care residents choosing to subspecialize or become hospitalists, primary care access is likely to worsen. The shrinking proportion of primary care physicians does not reflect the growing demands of an aging U.S. population. Primary care physicians are more likely to provide care in rural areas and safety net settings relative to other subspecialties.5

Among noteworthy advocacy responses to these trends, major U.S. family medicine organizations have collectively declared a “25 by 30” goal, hoping to see 25% of all U.S. medical school graduates selecting the primary care discipline by 2030.6 Still, the need for policy attention to these developments is even greater and more acute today than in 2010. Evidence-based reforms are needed to enhance educational exposures, graduate medical education financing, and downstream payment for learners interested in primary care, while also reducing burnout.

Tabe 1: National Physician Estimates, 2018
Tabe 1: National Physician Estimates, 2018:

Physician type

No. of physicians

% of all physicians

Tabe 1: National Physician Estimates, 2018:

Non-PC physicians

479,839

66%

Tabe 1: National Physician Estimates, 2018:

PC physicians

217,208

30%

Tabe 1: National Physician Estimates, 2018:

Hospitalists*

29,068

4%

Tabe 1: National Physician Estimates, 2018:

Total physicians

726,115

100%

CMS = Centers for Medicare and Medicaid Services; PC = primary care.

*—Physicians with PC specialty training working primarily in hospitals (more than 90% of claims).

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3 The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare.

Table 2: National PC Physician Estimates, 2018 
Table 2: National PC Physician Estimates, 2018 :

PC physician type

No. of physicians

% of all physicians

% of PC physicians

Table 2: National PC Physician Estimates, 2018 :

Family medicine

86,958

12%

40%

Table 2: National PC Physician Estimates, 2018 :

General internal medicine

72,404

10%

33%

Table 2: National PC Physician Estimates, 2018 :

General pediatrics

49,410

7%

23%

Table 2: National PC Physician Estimates, 2018 :

General practice

4,620

1%

2%

Table 2: National PC Physician Estimates, 2018 :

Geriatrics

3,816

1%

2%

Table 2: National PC Physician Estimates, 2018 :

Total PC physicians

217,208

30%

100%

CMS = Centers for Medicare and Medicaid Services;​ PC = primary care.

Data from the 2018 American Medical Association Physician Masterfile. We adjusted for retired physicians using methods developed by Petterson, et al., 2016.3 The undercount of osteopaths was supplemented using 2016 CMS National Plan and Provider Enumeration System and 2016 CMS Physician Compare. 

References

1. Council on Graduate Medical Education. Twentieth report. Advancing primary care. December 2010. Accessed March 20, 2019. https://​bit.ly/2LypPH1

2. Kuo YF, Sharma G, Freeman JL, et al. Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009;​360(11):​1102-1112.

3. Petterson SM, Rayburn WF, Liaw WR. When do primary care physicians retire? Implications for workforce projections. Ann Fam Med. 2016;​14(4):​344-349.

4. Wilkinson E, Bazemore E, Jabbarpour Y. Ensuring primary care access in states with an aging family physician workforce. Am Fam Physician. 2019;​99(12):​743. Accessed July 16, 2019. https://www.aafp.org/afp/2019/0615/p743.html

5. Petterson S, McNellis R, Klink K, et al.;​ Robert Graham Center. The state of primary care in the United States:​ a chartbook of facts and statistics. January 2018. Accessed March 20, 2019. https://​bit.ly/322arZ8

6. Kelly C, Coutinho AJ, Goldgar C, et al. Collaborating to achieve the optimal family medicine workforce. Fam Med. 2019;​51(2):​149-158.

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, February 1, 2019. Am Fam Physician. 2019;99(3):153. This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor for AFP.