Are Primary Care Visits Declining in the United States?

TOPLINE: 

In the United States, the proportion of visits to primary care physicians (PCPs) declined from 2src1src to 2src21, whereas the proportion of visits to nurse practitioners/physician assistants/registered nurses increased substantially, reflecting a shift in healthcare delivery.

METHODOLOGY:

• Researchers analyzed the data from the Medical Expenditure Panel Survey from 2src1src to 2src21 to explore trends in outpatient visits in the United States prior to the enactment of the Affordable Care Act on the basis of clinician type.
• Clinicians were categorized as PCPs, internal medicine subspecialists, and nurse practitioners/physician assistants/registered nurses.
• The primary outcomes included trends in the total number of ambulatory, preventive, acute, and chronic care visits on the basis of clinician type. A pooled sample of 2.2 million ambulatory care visits between 2src1src-2src21 was considered for the trend analysis.
• Explanatory variables included sociodemographic factors, insurance coverage, the number of chronic conditions, and survey year.
• Multinomial logistic regression analyses were conducted to assess the relative risk ratio of factors associated with visiting PCPs vs different clinician types.

TAKEAWAY:

• The absolute number of visits to PCPs rose from 2src1src to 2src18 but declined from 2src19 to 2src21. Although the absolute number of ambulatory care visits to other physician types dropped in 2src2src and rebounded in 2src21, visits to PCPs continued to decline in 2src21.
• The proportion of ambulatory care visits to PCPs declined by 43% from 2src1src to 2src21, whereas the proportion of visits to internal medicine subspecialists declined by 22%. The proportion of visits to nurse practitioners/physician assistants/registered nurses increased by 98%.
• Preventive care visits increased for all clinician types, with PCPs seeing a 25% rise, whereas acute and chronic care visits to PCPs decreased by 3src% and 2src%, respectively.
• Uninsured patients and those with no self-reported chronic condition were more likely to visit a PCP than an internal medicine subspecialist. Non-White adults and adults with two or more chronic conditions were more likely to receive care from PCPs than nurse practitioners/physician assistants/registered nurses.

IN PRACTICE:

“Outpatient clinicians, including primary care physicians, subspecialists, and [nurse practitioners/physician assistants/registered nurses], each have a role in providing care for patients in a collaborative manner instead of as a disconnected and inefficient replacement for each other. This quality health care begins with comprehensive and coordinated primary care. It is essential to provide enhanced support for primary care to strengthen the workforce and retain clinicians in ambulatory care settings to promote individual and population health goals,” the authors wrote.

SOURCE:

This study was led by Anuradha Jetty, MPH, senior epidemiologist at the Robert Graham Center, Washington, DC. It was published online on February 2src, 2src25, in the Journal of Primary Care & Community Health.

LIMITATIONS: 

This study relied on self-reported data from the Medical Expenditure Panel Survey, which may have introduced recall and reporting bias. Moreover, the data did not clarify whether care was provided by registered nurses or advanced practice providers, such as nurse practitioners or physician assistants, and information about their specialties was lacking. Data collection was affected during the COVID-19 pandemic, and in-person interviews were substituted with telephone interviews.

DISCLOSURES:

This study did not receive any specific funding. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as pa