Relationship Between Primary Care Physician Capacity and Usual Source of Care.

BACKGROUND: The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC. METHODS: Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity. RESULTS: The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas. CONCLUSIONS: Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.

Osteopathic Medical Schools Produce an Increasing Proportion of Family Medicine Residents.

The Association of American Medical Colleges reported a shortage of 45,000 primary care physicians in 2020 and projects shortages of 65,000 by 2025 and 104,900 by 2030.1 The shortage has been exacerbated by physician retirement due to the COVID-19 pandemic.2 The increasing deficit is partially because of the decline in medical students entering primary care specialties. Interest in family medicine has been flat for the past 10 years, and only 13% of U.S. allopathic and osteopathic graduates enter Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine programs.3 Most recent residency matches report that only 9% of allopathic medical students choose family medicine.4 There has been more interest in primary care in osteopathic schools, with 23% of these students expressing an interest in primary care.5.

Family Medicine Research Is Not a Federal Priority.

Research in family medicine produces clinical information and improves care delivery, but it has yet to receive equitable federal investment. The National Institutes of Health (NIH) is the primary funder of medical research in the United States. In 2021, the NIH received $45 billion.1 Between 2017 and 2021, the NIH spent only 0.2% of its budget on family medicine research (Figure 1). Although other funding organizations exist, the NIH is the largest funder of biomedical research, and because it continues to undervalue family medicine research, its underinvestment impacts clinical care.

Family Medicine and Emergency Redeployment: Unrealized Potential.

BACKGROUND AND OBJECTIVES: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. METHODS: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare's 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. RESULTS: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. CONCLUSIONS: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Point-of-Care Ultrasound Use by Primary Care Physicians.

Despite the proven benefits, less than 10% of physicians have adopted point-of-care ultrasound in primary care. Physician and practice characteristics, such as being a family physician and working in rural settings, increase the odds that a physician will adopt POCUS in their practice.