Primary care shortage affects 44 million Americans

Thirteen percent of Americans –– or 44 million –– live in a county with a shortage of primary care physicians, according to a study done by United Healthcare. Such counties have fewer than one physician for 2,000 residents.

A lack of nearby doctors is a far more common problem in rural areas. Thirty-eight percent of people who live in rural areas live in a county with a physician shortage, compared to only 8 percent of those who live in urban areas.

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However, in absolute numbers, there are about as many city-dwellers who live in doctor-deficient counties as rural residents: 21 million compared to 23 million.

There are a few states that don’t have any such counties. In six New England states, there is only one county (in northeastern Vermont) defined as experiencing a shortage in primary care physicians. None of the counties in Hawaii or Delaware have shortages, either.

The shortages appear to be the most severe in the South, Appalachia, Texas and the Great Plains states.

Unfortunately, it looks like the problem will only get worse in the coming years. Not only is the population increasing, but the population of older people who are most likely to be dealing with health issues is increasing particularly fast.

Medical schools aren’t producing enough new primary care physicians to meet the growing demand. Currently, about a third of all physicians practice primary care. However, in 2017, only one in six medical student graduates spent their residency in primary care.

The good news, states the report, is that there is a growing force of nurse practitioners and physician assistants who are increasingly making up for the shortage of PCPs.

While physician assistants are no more likely to practice primary care than physicians, a whopping 78 percent of nurse practitioners are in primary care.

Moreover, says the report, “NPs are more likely than primary care physicians to practice in underserved communities, including rural areas, and to accept new patients.”

The report is skeptical that the lack of an MD means much in terms of patient care, concluding that the quality of care delivered by NPs and PAs is “comparable” to that offered by physicians.

The increase in retail health and urgent care centers is another significant positive trend. There are over 7,400 urgent care centers and 1,800 retail health clinics.

The report recommends that states remove laws that restrict what NPs can do and allow them “to practice to the full extent of their education and training.” Putting in place such policies would reduce the number of people living in counties with insufficient primary care access from 44 million to 13 million.