What You Should Know:
– The U.S. has seen a consistent decline in primary care clinicians since 2014 due to fewer clinicians entering the workforce, increased rates of burnout and decreased direct patient care, according to the latest evidence report from the Primary Care Collaborative and Robert Graham Center.
– The report, Health is Primary: Charting a Path to Equity and Sustainability reveals the United States has seen a consistent decrease in the number of primary care clinicians since 2014, caused by a decline in the number of clinicians entering primary care, burnout leading to retirement, and decreased direct patient care time. In 2019, there was a net loss of 10 clinicians per 100,000 people across the United States. Spending on primary care fell from an average of 6.2% in 2013 to 4.6% in 2020.
Multifaceted Approach to Rebuild Primary Care
Experts recommend a multifaceted approach to rebuilding primary care that outlines steps policymakers, providers, and employers can take, including:
– Offering more primary care training opportunities and incentives for clinicians to select primary care as a specialty,
– Collecting accurate and transparent workforce and primary care financing data,
– Establishing a hybrid primary care payment option alternative to fee-for-service for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) and more broadly across public and private programs,
– Crafting solutions to mitigate the primary care barriers of high deductible health plans, and
– Supporting today’s primary care workforce by lowering administrative burdens and building diverse teams to address the range of patient primary care needs.
Having access to a regular source of primary care is associated with fewer emergency department visits and hospitalizations, lower odds of dying prematurely, and lower healthcare costs. Data from MSSP, Medicare’s largest ACO program serving 11 million beneficiaries, consistently indicates that primary care-focused ACOs (more than 75% of clinicians are primary care) provide higher-value services on a population basis, producing more than twice the savings as hospital-based ACOs. In 2022, MSSP saved Medicare $1.8 billion.
Factors Contributing to Primary Care Access Issues
The report examines the supply and demand factors that contribute to primary care access issues. It also considers innovations such as direct primary care, telehealth, and retail clinics that aim to provide more equitable access but may pose unintended community-level financial burdens and access issues. Despite increased uptake of these care options, one-in-four U.S. residents currently do not have a relationship with a primary care clinician, and 40% of adults in the United States failed to have a primary care visit in 2019. These trends have been exacerbated by the COVID-19 pandemic, suggesting that the situation may be more dire than the report’s data reflect.
“High-tech healthcare grabs the headlines, but high-touch, personalized primary care with tech support keeps people healthier at a lower cost,” said Ann Greiner, president and CEO of PCC. “If we are serious about improving the health of everyone in every community, policymakers need to step up to strengthen primary care, making it attractive to clinicians and delivering what patients want – comprehensive team-based care.”
