New PCP Shortage Numbers Call for 27% Bump in Residency Slots

Marcia Frellick

March 10, 2015

New calculations say an additional 44,340 primary care physicians (PCPs) will be needed in the next 20 years to meet demand in the United States.

The numbers take into account effects of the Affordable Care Act, including the increasing numbers of insured; physicians' retirement age; and patient panel size, or the number of patients for whom a healthcare team is responsible, which is expected to decrease with new delivery models. Those factors, combined with changing roles for PCPs, have led to a projection that the shortage will pass 33,000 by 2035.

To fill the gap, Stephen M. Petterson, PhD, from the Robert Graham Center in Washington, DC, and colleagues call for a 27% increase (2200 first-year spots) in the number of PCP residencies by 2020.

Their study results were published in the March/April issue of the Annals of Family Medicine.

Numerous projections of physician shortages have been published in recent years, but this one updates information, projecting out to 2035, and peels away some layers to clarify the PCP workforce.

"It is a more robust approach to defining which physicians will actually constitute the current and future primary care workforce," coauthor Andrew Bazemore, MD, MPH, also from the Graham Center, told Medscape Medical News. "Many reports would say if you are an internist, a pediatrician, or family physician, you are in primary care." But many of those physicians are hospitalists, which fall outside the comprehensive definition of the PCP, he noted.

Researchers used 2010 National Ambulatory Medical Care Survey and US Census data to predict demographic changes and need for primary care services. Retirement trends came from the American Medical Association. The authors found that at current production rates (8049 each year), medical schools will produce 169,029 new PCPs by 2035. However, because of the number of PCPs who are retiring, this production cannot match need.

Researchers used an estimated retirement age of 66 years. If the age went to 64 years, the shortage increased to 38,622, whereas delaying retirement until 68 years reduced the shortage to 26,835.

New models designed to improve healthcare delivery also affect panel size, which increases the numbers of physicians needed. The authors note that to implement patient-centered medical homes, for instance, Group Health Cooperative of Puget Sound in Washington reduced panel sizes from 2327 to 1800 patients.

The authors assumed a ratio of population to primary care physicians of 1406 to 1 in 2015, so a 10% decrease in panel size results in shifting 141 patients per physician. "Our calculations indicate that if this shift occurs nationwide, shortages will increase dramatically," they write.

Dr Petterson told Medscape Medical News that most of the needed growth comes from population growth, and just as we will need more teachers and police officers, we will naturally need more physicians.

In addition, the number of residency slots needed to meet demand varies by year, reaching a peak of 2710 in 2025, but dropping to 1700 by 2035.

Bridging the gap will not only take adding more slots but also a change in reimbursement and debt assistance that will make the specialty more appealing to medical students, Dr Bazemore said.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2015;13:107-114. Full text

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