Study: Increases in primary care providers not bringing expected public health gains

May 7, 2019

A recently-published study shows that even though the number of primary care doctors in the U.S. has been increasing, the gains have not been evenly distributed.

Doctors and health policy experts have long known that access to primary care is the foundation of good population health. But a recently-published study shows that even though the number of primary care doctors in the U.S. has been increasing, the gains have not been evenly distributed.

The study, which examines the relationship between the number of primary care doctors and mortality across the U.S. between 2005 and 2015, notes that the number of primary care doctors actually increased from 196,014 to 204,419 during the decade the study covers.

But the growth in the nation’s population during that time, combined with a loss of primary care doctors in some counties, resulted in a decrease in the number of primary care doctors from 46.6 to 41.5 per 100,000 population, with most of the loss occurring in rural areas. The study was published in the April 2019 edition of JAMA Internal Medicine.

That trend has important public health implications, given the association this and other studies have found between life expectancy and the number of primary care physicians in a given area. The JAMA study found that every 10 additional primary care physicians per 100,000 population was associated with a 51.5-day increase in life expectancy, due largely to reductions in deaths from cardiovascular and respiratory diseases and cancer. 

All of these, the authors note, are “conditions with strong evidence of amenability to primary care management or with delayed mortality conditional on early screening through primary care.”

The authors say the study points to a need for policies that will help further increase the number of primary care doctors. Initiatives that place more emphasis on primary care, such as accountable care organizations, are a start, but the government also needs to take steps such as eliminating the pay gap between primary care providers and specialists in order to fully realize the population benefits of primary care.