Primary Care Workforce Crossroads: A call for new research
High quality primary care is the foundation of our nation’s healthcare system[i]. Research points to the essential role of primary care clinicians and services in improving access, quality, life expectancy, and affordability.[ii],[iii] While the Milbank Memorial Fund’s Health of US Primary Care Scorecard finds the overall primary care workforce has increased slightly in recent years,[iv] recent reports from HRSA’s Bureau of the Health Care Workforce anticipate shortages ahead[v] even when including nurse practitioners and physician assistants in the mix.
Recognizing the benefits of primary care, policymakers in nearly 20 states are working closely with public and private payers, providers, and purchasers to increase investment and enable primary care providers to meet demands for basic services for an increasingly complex patient population. Proposals to address the shortfall cover a broad range of strategies and key actors and are complex—low compensation compared to other health occupations, addressing burnout and job dissatisfaction, and replenishing an aging and minimally diverse workforce—and will take several years to implement and realize benefits.
If media coverage and public discourse are reliable indicators, Americans are already experiencing limitations on access to preventive and non-emergent care, regardless of geography, source of insurance, or health system. Administrative data — the most likely analytic resource — has not yet been able to clearly show when a board-certified or licensed professional is actually providing primary care to some or all patients seen. Also less clear is the measurable impact on chronic disease, prevention, and well-being, and the consequences of inaction. More work is needed to define and measure the impacts of declining primary care workforce levels on well-established health status measures and to project those impacts into the years ahead as the primary care workforce continues to shrink.
- How will disease rates and severity change with less primary care provider access?
- How might health disparities widen?
- How will hospital utilization for acute conditions change?
Using existing data resources such as claims databases, quality measures, hospital and emergency department data, and workforce history, analysts can help policymakers strategize and plan ahead for the short-term constraints anticipated over the next decade.
Sources:
[i] 2019-PCPCC-Evidence-Report-Final.pdf (milbank.org); Investing in Primary Care: Why It Matters for Californians with Commercial Coverage (chcf.org)
[ii] Basu S, Phillips RS, Berkowitz SA, Landon BE, Bitton A, Phillips RL. Estimated Effect on Life Expectancy of Alleviating Primary Care Shortages in the United States. Ann Intern Med. 2021 Jul;174(7):920-926. doi: 10.7326/M20-7381. Epub 2021 Mar 23. PMID: 33750188.
[iii] Sharma A, Basu S. Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States? J Prim Care Community Health. 2022 Jan-Dec;13:21501319221125471. doi: 10.1177/21501319221125471. PMID: 36222656; PMCID: PMC9561680.
[iv] The Health of US Primary Care: 2024 Scorecard Data Dashboard | Milbank Memorial Fund https://www.milbank.org/publications/health-of-us-primary-care-a-baseline-scorecard/
[v] Health Workforce Projections | Bureau of Health Workforce (hrsa.gov), https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-of-primary-care-workforce-2023.pdf