ACA Will Require 3% More Primary Care Physicians by 2025

November 12, 2012

The Affordable Care Act (ACA), experts predict, will only deepen a shortage of primary care physicians brought on by a growing — and aging — population.

But to what extent? A new study in the Annals of Family Medicine offers a hard number. It will take an extra 8000 primary care physicians in 2025 just to treat patients who obtain insurance coverage under the law, according to lead author Stephen Petterson, PhD, and coauthors.

In all, they write, the nation will need 52,000 more primary care physicians in 2025 than it has now, a figure resembling estimates in other recent studies. Before Congress enacted the ACA in 2010, the Association of American Medical Colleges had forecast a shortfall of 46,000 primary care physicians by 2025.

In the Annals of Family Medicine study, sheer population growth accounts for 33,000 of the 52,000 extra physicians needed in 2025, according to Dr. Petterson, the research director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, affiliated with the American Academy of Family Physicians, and colleagues. Another 10,000 physicians of the total reflect the higher level of services used by baby boomers on the rolls of Medicare.

The ACA will extend insurance to roughly 30 million more Americans through 2019. The 8000 primary care physicians required by this expansion represent a 3% increase of the current workforce.

As a baseline for their projection, Dr. Petterson and co authors used the 246,090 primary care physicians who were engaged in direct patient care in 2010 as reported by the American Medical Association. They whittled down that number to almost 209,000 after excluding physicians who were retired, working as hospitalists, or working in emergency departments and urgent-care centers.

To calculate how many primary care physicians will be needed in 2025, the authors estimated the number of primary care office visits that would occur that year and divided it by the current number of annual visits per physician, which is 2237. According to this math, the United States ought to have almost 261,000 primary care physicians 13 years from now, a 25% increase over 2010.

Coauthor Andrew Bazemore, MD, MPH, director of the Robert Graham Center, called the workforce growth required by just the ACA "a surprisingly small proportion" of the total.

Fielding an additional 52,000 primary care physicians in 2025 is a daunting task, Dr. Bazemore said, given long-term preferences of most medical students for other specialties. However, in the last 2 to 3 years "we've seen an uptick in the number of medical student seniors choosing family medicine," he said. That trend, along with proposals to increase the number of residency training slots and earmark more of them for primary care, justifies "a little more optimism," he added.

At the same time, the healthcare system needs to not only grow the primary care workforce, but also do a better job allocating clinicians to underserved areas.

"You need to find a way to get the doctors to where they're needed," Dr. Bazemore said.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2012;10:503-509.

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