By Liz Carey
A new study from the Robert Graham Center of the American Academy of Family Physicians (AAFP), co-sponsored by the Milbank Memorial Fund and the Physicians Foundation, found that communities across the country are struggling to meet the demand for primary care physicians because . as well as to retain these doctors in their communities. While it’s hard everywhere, said Dr. Yalda Jabarpour, lead researcher on the study, it’s harder for rural communities.
“Ten years ago, we knew we had a problem with primary care physician density,” Jabbarpour said in an interview with the Daily Yonder. “Today, even though people are older and therefore sicker, and the population is growing and the demands are higher, we actually have fewer doctors to meet that need.”
Rural communities tend to depend more on primary care physicians, Jabbarpour said, especially family doctors.
In 2021, 37 percent of all physicians-in-training (residents) began training in primary care, but only 15 percent of all physicians were practicing primary care three to five years after residency, the study found.
More than half of residents with the potential to enter a primary care subspecialty or have become hospitalists instead, a study shows. And only 15% of primary care residents spend most of their time training in the ambulatory setting, where the majority of the US population receives their care, and less than 5% of primary care residents spend time learning in rural and other underserved communities, the researchers found.
The AAFP study also found that there is a slightly higher density of primary care providers in rural and underserved areas. Looking at the social drivers of health – such as housing, transport, income and education – and how they affect the health status of residents, the study found that people in areas with more social disadvantage (less suitable housing, barriers to transport and -low income, for example) had higher rates of chronic disease and poorer health outcomes.
In 2021, the overall density of primary care in areas with more social disadvantage was 111.7 per 100,000, while the density of areas with less social disadvantage was 99.5 per 100,000. However, the researchers said that while these measures to be encouraging, they are still insufficient.
“This finding may be attributable in part to the success of the community health center movement, which aims to place clinicians in areas of highest social need,” the researchers said. “However, this promising finding must be tempered by the reality that even this higher density of primary care clinicians may not meet patient demands, given that people living in high-need areas tend to have higher levels of medical need.’
“Rural areas are doing much better in training and retaining a primary care workforce, but at the same time, this is still not enough to meet the growing demand,” Jabbarpour said.
Family medicine, like any other medical specialty, she said, is distributed in the same way as the U.S. population. Rural areas nationwide, according to the US Census Bureau, are home to 19.88% of the total US population. Jabbarpour said a corresponding percentage of primary care physicians will be located in rural areas. But because rural communities are statistically older and sicker, the need for rural communities is greater.
One way to solve the problem would be more investment in primary care, the study found. The Centers for Medicare and Medicaid (CMS) shift in overall health care spending to primary care would help invest more federal dollars in primary care, as would investments by the US Department of Health and Human Services ( HHS) in new rural health clinics, health centers and Indian Health Service (IHS) facilities in underserved areas, the report said.
“The United States underinvests in primary care, and the Medicare fee schedule — which lists fees for services — is the main culprit,” the report said. “It undervalues primary care services relative to specialty services and pays on a visit basis, discouraging non-visit services such as emails and phone calls, as well as care by other members of the primary care team.”
Jabbarpour said another key to attracting more primary care doctors to rural communities is for colleges to recruit from rural communities.
“Medical schools need to recruit from these communities because people tend to come home to practice,” she said.
Bringing doctors to rural areas also means helping their spouses find work.
“There are doctors who want to go to rural areas, but their partners don’t have opportunities to work in rural areas if they’re not in medicine as well,” she said.
The best way to attract rural primary care physicians, she said, is to expose them to it. The study found that doctors who trained in teaching health centers and rural training tracks were more likely to practice in these communities.
“I know that not every rural area is the same. In some rural areas, it’s probably an area that doctors would be happy to live in and raise their families if they knew about it,” she said. “I know it’s difficult because it requires hospital systems to really actively recruit or create rural training tracks and reach out to medical schools across the country and say, hey, send your students here, we’ll give them housing and they can get exposure to this beautiful piece of paradise that we have and then they will want to come here.
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