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Primary Care Spending and Workforce Deficits

NOMINATED TOPIC | May 28, 2022

1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

Is it possible for expansions of health care professional graduates to address shortages of generalists and general specialists across 40% of the US population with half enough primary care, mental health, women's health, and basic surgical workforce chronically?

2. Why are you struggling with this issue?

NP graduates have been increasing at 6% a year, doubling each 12 years since the 1990s. PA graduates and osteopathic graduates have doubled each 14 years with a 5% annual increase. US MD has been increasing by 3 to 4% a year since 2003. There is no sign that deficits have been addressed.
The PA and DO contributions to primary care have been cut in half with each doubling of annual graduates for no gain. US MD contributions to primary care have declined by class year despite expansions.
Nebraska and Kansas have had superior pipelines that document 10 - 12 times instate practice location where needed - and yet the deficits remain.
It appears that training interventions cannot resolve deficits of workforce. The concentrations of elderly, poor, and worst employers in these counties suggests that deficits of workforce are shaped and maintained by the worst Medicaid, Medicare, and private health plans concentrated in these counties.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

I want some recognition of the limitation of the financial design as shaping deficits of workforce. With only 5 to 6% of spending, primary care is unable to address deficits. In 2008 this translated to about 38 billion dollars for primary care in 2621 counties lowest in health care workforce with 40% of the US population. Since that time revenue has been flat, usual costs of delivery have gone up, and micromanagement types have increased and have cost more for each, especially in deficit areas. Medicare data from 2001 indicates 15% lower office payments in these counties with progressively lower payments as health care workforce levels decrease.

4. When do you need the evidence report?

Mon, 01/01/2024

5. What will you do with the evidence report?

The evidence can be used to point out to health care leaders that a financial design change is the only way to address half enough generalists and general specialists for half of the nation. This is because the 40% in 2621 counties lowest in health care workforce should reach 50% of the US population by 2060 given fastest and steady rates of growth for the past 50 years. Also hospitals and practices have been stagnant to declining in these counties that are clearly growing fastest in population numbers, demand, and complexity.

Supporting Documentation

Researcher focused upon Basic Health Access (Word, 208 KB)

Optional Information About You

What is your role or perspective? Basic health access researcher

May we contact you if we have questions about your nomination? Yes

Page last reviewed May 2022
Page originally created May 2022

Internet Citation: Primary Care Spending and Workforce Deficits. Content last reviewed May 2022. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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