Primary care growth slows as more specialists join physician workforce

The number of specialist jobs grew significantly faster than primary care physician jobs, according to a Health Affairs blog post.

The blog is penned by Michael Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation Lab at Boston-based Harvard Medical School; Bob Kocher, MD, a partner at Venrock in Palo Alto, Calif.; healthcare analyst Nikhil Sahni; and Christopher Barbey, a research assistant in the Department of Health Care Policy at Harvard Medical School.

For the blog, researchers examine data from the Bureau of Labor Statistics between 2005 and 2015 to determine changes that have occurred in the nation's physician workforce. They specifically looked at ambulatory healthcare services, hospitals and nursing and residential care facilities. Researchers said they considered "primary care physicians" as family and general practitioners, general internists, obstetricians and gynecologists, and general pediatricians. Other physicians were considered "specialists."

Researchers ultimately found a net increase of 2.6 million healthcare jobs during the time period studied, with physician jobs making up 6 percent. Specialist physician jobs grew by approximately 48 percent between 2005 and 2015, compared to an increase of approximately 8 percent for primary physician jobs during that time period.

"In an era when we might have expected (and hoped for) rapid primary care physician growth, the share of the physician workforce devoted to primary care actually decreased from 44 percent to 37 percent, and the number of primary care physicians per capita has remained roughly flat," the blog authors wrote.

Researchers noted the growth rate for primary care increased (17 percent) by including physician assistants and nurse practitioners as primary care. They said this indicates "we are addressing our increasing primary care needs with non-physician labor, but more research is needed to understand the clinical and economic ramifications of that trend."

They also noted the increasing number of specialist physician jobs "would not necessarily be negative for healthcare spending" with the right circumstances.

"As our data suggest, past initiatives such as low interest loan programs, training grants, or service programs such as the National Health Service Corps, which provides students with loan forgiveness in exchange for a commitment to practice primary care in underserved areas, have met limited success. The workforce continues to shift toward specialists. If we are to bend the cost curve, we likely need to move more aggressively on fee schedule changes, payment reform and workforce policies," the blog authors conclude.


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