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Our Take

Estimating local need for primary care providers

15 Minute Read

Primary care is an integral part of the health care ecosystem, with primary care physicians (PCPs) and advanced practice providers (APPs) often acting as the first – and sometimes only – contact point for patients. While recent estimates indicate the US will see a shortage of up to 48,000 primary care providers by 2034, which rivals projections for all other specialties combined, this shortage will not affect all markets equally.

As burnout, preferences for fewer hours, other lingering aspects of Covid-19, and alternate employment options persist, it will be increasingly important to understand your local primary care need. While primary care supply and demand can be calculated using various methods, a visit-based approach can help organizations best understand and prepare for a potential primary care shortage in their markets.

 

The conventional wisdom

Based on current workflows, the AAMC predicts that the US will see a shortage of up to 48,000 PCPs by 2034. Some organizations assume this shortage will be equally distributed across the country and that their market will experience a shortage relative to the national estimates, but that is not the case. While some markets will experience a significant undersupply of primary care providers, others may not be undersupplied at all. Our experts have found that certain capacity investments and alternate providers may significantly reduce or eliminate future primary care shortages, especially if they are already prevalent in a local area.

However, even those who realize the national figures are not one-size-fits all and take a more localized approach to understand need may rely on panel size estimates. While a panel size approach is not necessarily wrong and is important for value-based care and quality, the method has some crucial limitations.

First, the timeframes used to set the panel size are variable. While the industry standard is approximately 18 months, many people still use 24 months, and some methodologies rely on 12-month benchmarks.

Second, panel ownership differs depending on state laws and regional or system-based practices. For example, in some states only primary care physicians can have a panel so any patients seen by advanced practice providers are included in a PCP’s panel size.

Third, panel size estimates themselves are often outdated or highly variable by population factors such as age and insurance coverage.

Finally, panels do not sufficiently account for emerging primary care disruptors like telehealth.

 

Our take

Through our research on the topic and conversations with thought leaders actively working on these problems, we recommend health care leaders model primary care need for their specific market with a visit-based approach:

1. Assess primary care need at the local level

Primary care need differs from market to market due to a variety of factors, including local population, patient demographics, and staffing structures. Market-specific assessments can be adjusted to account for those factors. Additionally, primary care shortages cannot be addressed with one-size-fits-all solutions. Using market-specific data rather than national data can help organizations develop more targeted strategies for their unique situations.

2. Use a visit-based methodology to calculate primary care need

To size primary care provider need, organizations should use a visit-based approach. Visit time is often tracked in electronic health records and other quality reports. This makes the data more likely to be up-to-date and readily available for a particular area. Furthermore, visit time is tracked and measured in a standard way across provider types, regardless of full-time status and delivery mediums, i.e., whether a patient is seen in an office or virtually. Taking a visit time approach also allows for a more comprehensive and accurate assessment of local primary care need as provider types, delivery mediums, and more may shift over time.

 

Four steps to calculate a PCP undersupply or oversupply

  • Step

    Estimate primary care visit demand

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    Estimate primary care visit supply

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    Estimate the contribution of APPs

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  • Step

    Estimate need for primary care

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Parting thoughts

By assessing primary care need at the local level with a visit-based approach, organizations can capture a more comprehensive and nuanced representation of their unique situation, develop market-specific strategies to either prevent or overcome a primary care shortage, and reliably adjust to variations that may arise in the future.

Visit-based provider demand and supply estimates are a critical starting point to determine current primary care need, but they are only one piece of the puzzle. The same calculations can be done using projected population size and provider counts to estimate projected need. It is also important to consider how disease prevalence, population demographics, alternative staffing models, urgent care preferences, and primary care disruptors may influence need in your market.

If your organization does find a significant undersupply in your market, several capacity-savings solutions can help. Our firm has assessed these capacity interventions on a national scale. In contrast to the market-specific, moderate to conservative visit-based approach outlined here, the national model includes a range of visit estimates and relies on aggressive demand benchmarks to understand the full need and potential of capacity solutions. Regardless, understanding the national scale of capacity solutions can further your organization’s thinking on how to prepare for more targeted shortage estimates in your local market.

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