Supply Of Primary Care Physicians Research Articles

Effect of Student-Run Free Clinics on Family Medicine Match Rates: A Multisite, Regression Discontinuity Study.

Student-run free clinics (SRFCs) have been proposed as one educational strategy to increase medical students' interest in primary care careers. We sought to overcome gaps in the literature by investigating the effect of opening an SRFC at different institutions on institution-level match rates into family medicine, the largest source of primary care physicians in the United States. We connected a list of SRFCs from primary care clerkship directors and the Society of Student-Run Free Clinics with a database of institution-level match rates into family medicine from 2000 to 2018. Using regression discontinuity analysis, we assessed whether opening an SRFC would increase family medicine match rates. Across a sample of 58 medical schools in the United States, we found that SRFCs did not significantly change the number (P=.44) or percentage of medical graduates (P=.42) entering family medicine residency. We also found no significant effects of SRFCs on the number of students entering family medicine in different contexts, including public/private institutions (P=.47), geographic areas (P=.26), departmental administrative structures (P=.69), and institutions with higher historical rates of producing graduates entering family medicine (P=.22). Though SRFCs may potentially support other aspects of undergraduate medical training, they should not be used as a singular strategy for addressing shortages in the primary care workforce in the United States. Further educational research should examine multipronged strategies to increase the supply of early-career primary care physicians in the United States.

Factors Influencing Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates.

Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. Multi-institutional cross-sectional study. IM primary care residency graduates from seven residency programs from 2014 to 2019. Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05). Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice.

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis.

Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated. This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data. Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983-0.9995). Similar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract diseases, and traffic accidents. This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the significance of strengthening primary care in the South Korean healthcare system to improve the overall health and wellbeing.

Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019

Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019

An Analysis of Primary Care Physician Accessibility and Medical Resource Distribution in Eastern Quebec: Utilizing an Enhanced Two-Step Floating Catchment Area (E2SFCA) Methodology

Objective: The aim of this study is to evaluate the accessibility of primary care physicians (PCPs) in Eastern Quebec by employing an enhanced two-step floating catchment area (E2SFCA) methodology. This approach will facilitate the identification of patterns in primary care accessibility that may not be readily apparent through the use of regional availability measures. Methods: To evaluate the accessibility of primary care physicians (PCPs), an enhanced two-step floating catchment area methodology was utilized. This approach considers both the population supply of PCPs at the dissemination area level and the travel time between PCPs and dissemination areas. Additionally, a continuous distance decay function (β) was employed. Results: The enhanced two-step floating catchment area (E2SFCA) methodology is effective in identifying possibly underserved areas that could have otherwise appeared to have sufficient access when evaluated using traditional provider-to-population ratios. The availability of primary care services is contingent upon the presence of adequate road infrastructure. Populations residing in areas with limited access to main road networks may experience compromised access to primary care. This issue disproportionately affects vulnerable individuals who lack private transportation options. Conclusions: The application of the enhanced two-step floating catchment area methodology can facilitate the identification of areas experiencing a shortage of primary care physicians. This information can be used to inform the development of regional medical workforce programs, such as "plans régionaux d’effectifs médicaux", and to support the establishment of rural residency initiatives.

Correlating Access to Primary Medical Care and Veterinary Care Providers: A Novel Application of Spatial Gravity Modelling.

Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum.

Gastroenterology Specialist Supply and Early-Onset Colorectal Cancer Incidence and Mortality in the U.S., 2014-2018.

The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP). This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation. Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval,-11.0 to-0.1) but not with EoCRC mortality (P= .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval,-46.1 to-7.8) but not with EoCRC incidence (P= .077). Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.

Primary Care Physician Supply by County-Level Characteristics, 2010-2019

This study evaluates and compares US trends between 2010 and 2019 in per-capita primary care physician supply by county-level racial and ethnic minority concentration, poverty, rurality, and region.

Association of Physician Densities and Gynecologic Cancer Outcomes in the United States.

To evaluate whether there is an association between county-level obstetrician-gynecologist (ob-gyn) and primary care physician (PCP) densities and gynecologic cancer outcomes in the United States. A retrospective cohort study of gynecologic cancers (uterine, ovarian, and cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from the SEER database, population density from the United States Census Bureau, and physician density (ob-gyns and PCPs/100,000 females) from the Area Health Resources File. Backward stepwise regression models were used. Final analysis included 113,938 patients for stage at diagnosis analysis and 98,573 patients for 5-year survival analysis. Uterine, ovarian, and cervical cancers represented 60.0%, 25.0%, and 15.0% of patients, respectively. Most counties (57%) were nonmetropolitan and had a mean ob-gyn density of 8 per 100,000 females and a mean PCP density of 89 per 100,000 females. Multivariate analysis showed that increasing PCP density was associated with earlier stage at diagnosis (95% CI -6.27 to -0.05; P &lt;.05) and increased 5-year survival rates in cervical cancer (95% CI 0.03-0.09; P &lt;.05). Obstetrician-gynecologist density was not found to affect stage or survival outcomes for uterine or ovarian cancer. Analysis of sociodemographic factors for cervical cancer showed that median household income was negatively correlated with stage ( P =.01) and that the percentage of those with bachelor's degrees and metropolitan status were positively correlated with 5-year survival rates ( P &lt;.01). For uterine cancer, the percentage of Black females was positively correlated with stage ( P &lt;.01) and negatively correlated with 5-year survival rates ( P &lt;.01). Increasing PCP density, but not ob-gyn density, is associated with earlier stage at diagnosis and improved 5-year survival rates in cervical cancer. County-level sociodemographic factors, including population diversity, metropolitan status, educational attainment, and household income, were also correlated with outcomes across all cancer types. Targeting PCP supply and education in lower density counties may improve population-based care for cervical cancer.

Association of UV Radiation Exposure, Diagnostic Scrutiny, and Melanoma Incidence in US Counties

Although UV radiation exposure is the conventionally reported risk factor for cutaneous melanoma, an alternative exposure is diagnostic scrutiny: the more physicians look for and biopsy moles, the more melanoma they find. To assess the association of proxies for UV radiation exposure and diagnostic scrutiny with geographical patterns of melanoma incidence. This was a cross-sectional ecological analysis of the 727 continental US counties reporting to the Surveillance, Epidemiology, and End Results (SEER) Program (among a total of 3108 counties). Environmental data relevant to UV radiation exposure (from a variety of sources), Health Resources and Services Administration data relevant to diagnostic scrutiny, and SEER data on melanoma incidence among the non-Hispanic White population diagnosed with melanoma from 2012 through 2016 were combined. Data analysis was performed between January 2020 and July 2022. Three UV radiation proxies (UV daily dose, cloud variability, and temperature variability) and 3 diagnostic scrutiny proxies (median household income, dermatologists, and primary care physician supply). Melanoma incidence (in situ and invasive cancers). In total, 235 333 melanomas were diagnosed. Proxies for UV radiation exposure changed gradually across geography, while melanoma incidence and proxies for diagnostic scrutiny changed abruptly across contiguous counties. The UV daily dose, a variable the National Cancer Institute specifically developed for melanoma analyses, was uncorrelated with incidence (r = 0.03; P = .42). For context, smoking prevalence was highly correlated with lung cancer incidence in the same counties (r = 0.81; P < .001). Melanoma incidence was correlated with median household income (r = 0.43; P < .001). Counties with no dermatologists and shortages of primary care physicians had the lowest incidence, while counties amply supplied with both had the highest, despite having lower mean UV daily dose. There was little association between melanoma incidence and melanoma mortality (r = 0.09; P = .05), while the analogous association in lung cancer was strong (r = 0.96; P < .001). In this cross-sectional ecological study, the current geographical pattern of melanoma incidence across US counties was less associated with proxies for UV radiation exposure and more so with proxies for diagnostic scrutiny. Incidence-the fundamental epidemiologic measure of disease frequency-now had little association with the feared outcome of melanoma: death.

Physician Associates/Assistants in Primary Care: Policy and Value.

Since the new century, primary care physician supply has worsened. Analysts predict that health service demand in the United States will grow faster than physician supply. One strategy is the utilization of physician assistants/associates (PAs). Most PAs work full-time, and approximately one quarter are employed in family medicine/general medicine. PAs deliver primary care services in a team-oriented fashion in a wide variety of settings, including private health systems and community health centers. One fifth work in rural and medically underserved areas. Together PAs and nurse practitioners provide approximately one third of the medical services in family medicine, urgent care, and emergency medicine.

Local Supply Of Postdischarge Care Options Tied To Hospital Readmission Rates.

The extent to which patients' risk for readmission after a hospitalization is influenced by local availability of postdischarge care options is not currently known. We used national, hospital-level data to assess whether the supply of postdischarge care options in hospitals' catchment areas was associated with readmission rates for Medicare patients after hospitalizations for acute myocardial infarction, heart failure, or pneumonia. Overall, readmission rates were negatively associated with per capita supply of primary care physicians (-0.16percentage points per standard deviation) and licensed nursing home beds (-0.09percentage points per standard deviation). In contrast, readmission rates were positively associated with per capita supply of nurse practitioners (0.09percentage points per standard deviation). Our results suggest potential modifications to the Hospital Readmissions Reduction Program to account for local health system characteristics when assigning penalties to hospitals.

Using GIS to Understand the Influence of Hurricane Harvey on Spatial Access to Primary Care.

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system.

Relationship between the presence of primary care physicians and health-related quality of life.

BackgroundThe supply of primary care physicians is associated with better health outcomes and a lower total cost of health services. However, the effect of the presence or absence of primary care physicians on health‐related quality of life (QOL) is unknown. We comparatively investigated the health‐related QOL of ordinary citizens according to the presence or absence of a primary care physician.MethodsWe conducted an observational cross‐sectional study using a propensity score analysis. A questionnaire on health‐related QOL (SF‐36v2, age, gender, presence or absence of a primary care physician, and chronic disease status) was mailed to 2200 individuals identified through stratified random sampling. We used propensity scores to compensate for covariates and analyzed three component SF‐36 summary scores and subscale scores of the “primary care physician” and “no primary care physician” groups.ResultsValid responses were received from 1095 individuals (49.8%). The “primary care physician group” comprised 653 individuals (59.6%). The physical health component scores of the “primary care physician group” were significantly lower than those of the “no primary care physician group,” and the “mental health component” scores were significantly higher (p = 0.032, p = 0.009). For the subscales, scores for “vitality” and “mental health” were significantly higher in the “primary care physician group” (p = 0.014, p = 0.018).ConclusionsPatients who had a primary care physician with whom they could comfortably consult at any time had a high mental health component score, and low physical health component score in the health‐related QOL.

The Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational study

BackgroundBroadband access has been highlighted as a national policy priority to improve access to care in rural communities.ObjectiveTo determine whether broadband internet availability was associated with telemedicine adoption among a rural patient population in western Tennessee.MethodsObservational study using electronic medical record data from March 13th, 2019 to March 13th, 2021. Multivariable logistic regression incorporating individual-level characteristics with broadband availability, income, educational attainment, and primary care physician supply at the zip code level, and rural status as determined at the county level.SettingSingle health system in western Tennessee.ParticipantsAdult patients with one or more in-person or remote encounter in a health system in western Tennessee and residing in western Tennessee between March 13th, 2019 and March 13th, 2021 (N = 54,688).Outcome measuresCompletion of one or more video encounters in the year following March 13th, 2020 (N = 3199; 7%). Our primary characteristic of interest was the proportion of residents in each zip code with access to the internet meeting the Federal Communications Commission definition of broadband access, adjusting for age, gender, race, income, educational attainment, insurance type, rural status, and primary care provider supply.ResultsPatients in a rural western Tennessee health system were predominantly white (79%), residing in rural zip codes (73%) with median household incomes ($52,085) less than state and national averages. Patients residing in a zip code where there is 80 to 100% broadband access compared to 0 to 20% were more likely in the year following March 13th, 2020 to have completed both telemedicine and in-person visits ([OR; 95% CI] 1.57; 1.29, 1.94), completed only telemedicine visits (2.26; 1.71, 2.97), less likely to have only completed in-person visits (0.81; 0.74, 0.89), but no more or less likely to have accessed no care (1.07; 0.97, 1.18).DiscussionThe availability of broadband internet was shown to be one of many factors associated with the utilization of telemedicine for a rural, working-class community after March 13th, 2020.ConclusionsAccess to broadband internet is a determinant of access to telemedicine for patients in rural communities and should be a priority for policymakers interested in improving health and access to care for rural patients.

The impact of primary health care and specialist physician supply on amenable mortality in Mexico (2000–2015): Panel data analysis using system-Generalized Method of Moments

The study had a three-fold objective: (i) to estimate the amenable mortality rates and trends at a national and state level between 2000 and 2015 in Mexico; (ii) to estimate the contribution and trends of various causes of death to overall amenable mortality; and (iii) to determine the association between health system inputs and amenable mortality for the period 2000–2015. We used a panel dataset for the period 2000–2015. The following health care inputs were used in the analysis: density of general practitioners, specialists and nurses, as well as density of hospital beds. We find that amenable mortality fell from 136 per 100,000 in 2000, to 124.1 per 100,000 in 2015 nationally, with significant heterogeneity in the trends across states. Mortality due to infectious diseases, diseases of childhood, and cardiovascular diseases decreased, while deaths due to other non-communicable diseases, such as diabetes, increased. There was a significant negative association between the density of general practitioners and specialist physicians, and amenable mortality. Our results indicate that reducing the burden of non-communicable diseases must be a health system priority. Improvements in primary health care could lead to improved disease detection and earlier diagnosis which could further reduce amenable mortality in Mexico.

Dual-eligible beneficiaries and inadequate access to primary care.

To determine whether enough primary care providers are in close proximity to where dual-eligible beneficiaries live to provide the capacity needed for integrated care models. Secondary data analysis using dual-eligible enrollment data and health care workforce data. We determined the density of dual-eligible beneficiaries per 1000 population in 2017 for each of 3142 US counties. County-level supply of primary care physicians (PCPs), primary care nurse practitioners, and physician assistants was determined. One-third of the 791 counties with the highest density of dual-eligible beneficiaries had PCP shortages. Counties with the highest density of dual-eligible beneficiaries and the fewest primary care clinicians of any type were concentrated in Southeastern states. These areas also had some of the highest coronavirus disease 2019 outbreaks within their states. States in the Southeastern region of the United States with some of the most restrictive scope-of-practice laws have an inadequate supply of primary care providers to serve a high concentration of dual-eligible beneficiaries. The fragmented care of the dually eligible population leads to extremely high costs, prompting policy makers to consider integrated delivery models that emphasize primary care. However, primary care workforce shortages will be an enduring challenge without scope-of-practice reforms.

Changing Practice Patterns Among Canadian Primary Care Physicians: Cross-Provincial Analysis of Linked Health Data

IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine.&#x0D; Objectives and ApproachOur objectives were to compare practice patterns among early-career (&lt;10 years in practice) and established (10+ years) PCPs and to determine if any changes over time reflect cohort effects (attributes unique to recent cohorts of PCPs), or period effects (changes over time across all PCPs). We accessed linked population and physician registry data, physician billing data, hospital discharge records, and vital statistics in each of three Canadian provinces from 1996/7 to 2017/8. Physician fee schedules are negotiated separately by province which means that while fields capturing service dates, dollars billed, and diagnosis codes are directly comparable, other fields capture similar, but not identical information across provinces (e.g. specific fee codes and service location codes). We developed measures of services volume, continuity, and comprehensiveness of primary care that could be applied across provinces and used these to describe practice patterns over two decades and explore cohort and period effects.&#x0D; ResultsMeasures of service volume (total patient contacts, number of unique patients seen) and continuity are lower among early-career physicians but the gap between early-career and established physicians has not changed. Measures of comprehensiveness of care, including provision of services in home, long-term care, hospital, and emergency department, as well as indicators of focused practice, hospitalist and locum care show more varied patterns, with declines in comprehensiveness across all physicians, but more evidence of focused practice among early-career physicians.&#x0D; Conclusion / ImplicationsFindings have implications both for health workforce planning and organizational reforms to support access to comprehensive primary care.

Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study

ObjectiveTo identify county characteristics associated with high versus low well-being among high-poverty counties.DesignObservational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds...

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.