Q&A: Report shows primary care crisis is growing

Key takeaways:

• There was a net loss of about 10 clinicians per 100,000 people in the U.S. in 2019.
• The PCC president highlighted a hybrid payment model with more investment as well as strategies for retaining staff as possible solutions.

The decline in the number of clinicians and in spending in primary care over the last several years have exacerbated the current primary care crisis, according to a new report from the Primary Care Collaborative and Robert Graham Center.

“High-tech health care grabs the headlines, but high-touch, personalized primary care with tech support keeps people healthier at a lower cost,” Primary Care Collaborative President and CEO Ann Greiner, MCP, said in a press release. “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.”

The report highlighted a continuous decrease in the number of primary care clinicians over the last decade, with the net loss of clinicians per 100,000 people across the U.S. growing from 4.91 in 2014 to 10.11 in 2019.

The report further showed that when only considering the inflow and outflow of physicians, there was an ever-greater net loss of 14.22 physicians per 100,000 people based on more retirements than entrances, up from 8.03 in 2012.

Meanwhile, spending on primary care decreased from an average of 6.2% in 2013 to 4.6% in 2020 across all payers.

Greiner spoke with Healio about some of the report’s key findings and what solutions are needed to address the primary care crisis.

Healio: What are the key takeaways from the report?

Greiner: The situation is pretty challenging, and the data that we have are pre-COVID. I'm concerned that things haven't gotten better since the pandemic, and in fact, the health of the U.S. population's gotten worse. We have a lot of anecdotal evidence that the primary care platform is no stronger. That’s just concerning.

Healio: The report mentions a lack of relationships between physicians and patients. How can that be addressed?

Greiner: We've had a lot of new entrants to give people better access and convenience — everything from retail clinics to telehealth. That’s very helpful, because at 10 o’clock at night, if you have a child with an ear infection, it’s wonderful to be able to get that addressed.

However, in terms of being able to have your care addressed in a more holistic way, those solutions are more challenging because generally, you see someone who you may not know and you might not see again. They don't necessarily have your historic health records. They may not understand your social construct, your health history. So that's just more challenging, because the more information you have, the better you're able to understand the different puzzle pieces and figure out what may be going on with a patient and give them good advice.

Now, there's some health problems that are straightforward, like ‘I have a sore throat, and I might have strep.’ But there's other things that are more complex, and really are best treated by someone who knows you and knows you over time. This is our challenge. If we don't have a supply of primary care clinicians, it just becomes harder. There are other solutions that patients are getting that are “primary care services,” but not necessarily the kind of primary care that we know really keeps people healthy and restores them to health when they have a complex condition.

Healio: What are possible strategies for some of the other issues highlighted in the report?

Greiner: There are longer term solutions that are focused on attracting more people into primary care. But that's a very long-term trajectory. I think right now, given that the platform is not as strong as it needs to be to address the health of the nation, we need to think about strategies that will make primary care more attractive right now.

I think those are strategies to retain existing staff by offering them more flexibility in hours, more ability to practice across state lines. There should also be a mix of virtual and in-person care.

I think we also need to address this continued decline in investment in primary care. I think we need, as a nation, to invest more dollars into primary care and pay in a way that allows more flexibility in the way you deliver primary care.

We've called for a hybrid payment — a mix of prospective and fee-for-service payment. What a hybrid payment does is, you can be freed up from a face-to-face visit, even if it's remote, and think more creatively about how to provide care like group visits, like varying how much time you spend with patients, dependent on need. So, if you're paid on a prospective basis, at least in part, you are more likely to build out a team and can be more flexible on how you're delivering your care.

We really need a team to be able to address the multiple medical, behavioral health, and social needs that many patients have.

Healio: Anything else to add?

Greiner: We’re seeing press reports coming in from across the country about primary care access issues, and it's really touching everyone. That has been a reality for a long time in rural communities, in poor urban communities but now we're seeing this in wealthier urban and suburban communities.

I think there's a growing understanding of these access issues, and we call upon policymakers, both public and private, to make some bold changes, particularly in how we pay and how much we pay in order to address these challenges.

Reference:

• Health is primary: Charting a path to equity and sustainability. https://thepcc.org/sites/default/files/resources/pcc-evidence-report-2023.pdf?utm_source=bitly&utm_medium=link&utm_campaign=2023_evidence. Accessed Oct. 27, 2023.
• U.S. primary care crisis is getting worse, experts say. https://thepcc.org/2023/11/03/pcc-press-release-us-primary-care-crisis-getting-worse-experts-say. Published Nov. 3, 2023. Accessed Oct. 27, 2023.