Demand for Specialists Will Outpace Primary Care by 2025

Marcia Frellick

November 08, 2013

The demand for adult primary care services will grow by 14% in the next 12 years, according to a study published online November 4 in Health Affairs. However, with an aging population and expanded medical coverage, demand will grow even more markedly for specialized services.

Timothy M. Dall, managing director for healthcare and pharma at IHS Inc in Washington, DC, and colleagues estimate demand for vascular surgery will rise 31% by 2025, cardiology will rise 20%, and neurosurgery, radiology, and general surgery will rise by 18% each.

Indicators such as wait times for appointments show that the current supply of specialists already cannot keep up with demand. For example, in 2012, the average wait time to see a neurologist was 34.8 business days for a new patient visit and 30 days for a follow-up. In 2009, the average wait times for new patient visits were 27.5 days for a routine gynecological exam with an obstetrician/gynecologist, 16.8 days for orthopedic surgery for knee injury or pain, and 15.5 days for a heart checkup with a cardiologist. In comparison, the average wait time in 2009 was 20.3 days for a routine physical with a family practitioner.

Although the current study focused on providers for adults, the authors also found indications that the number of specialists who treat children is inadequate. In 2012, average wait times for appointments with some specialists at 69 children's hospital clinics were even longer than for adults, at 51 days for endocrinology, 52 days for child and adolescent psychiatry, and 54 days for dermatology, for example.

To estimate future demand, the investigators took into account numerous factors, including:

  • In just 12 years, the US population will have increased by 9.5%, and the population aged 65 years and older will grow by 45%, according to US Census Bureau projections.

  • The population with Parkinson's disease is projected to increase by 68% between 2010 and 2030.

  • By 2025, the elderly population with Alzheimer's disease is expected to increase 40%, according to the Alzheimer's Association.

  • The National Cancer Institute projects 18.1 million more cancer survivors by 2020 (up 30% from 2010).

  • The proportion of elderly Americans with chronic disease rose from 86.9% in 1998 to 92.2% in 2008.

Demand for specialist services varies greatly by state, depending on population growth and numbers of newly insured, the authors note. For example, although demand nationally for cardiologist services is expected to grow 20% in the next 12 years, the projected increase is 5% in West Virginia and 51% in Nevada.

The researchers conclude that failure to train both adequate numbers and an appropriate mix of specialists as well as primary care physicians, "could exacerbate already long wait times for appointments, reduce access to care for some of the nation's most vulnerable patients, and reduce patients' quality of life."

Health Aff. Published online November 4, 2013. Abstract

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