Physician visits decreased from 2010 to 2021, study finds
U.S. data showed that visits to primary care physicians and internal medicine subspecialists declined by 43% and 23%, respectively, while visits to nurse practitioners, physician assistants, and registered nurses increased by 98%.
Visits to physicians from 2010 to 2021 decreased while visits to nonphysician clinicians increased, a study found.
To understand how recent factors like state Medicaid expansions, COVID-19, population growth, and downstream effects of the Affordable Care Act have influenced primary care use, researchers looked at trends in Medical Expenditure Panel Survey data from 2010 to 2021. Adults who responded to the survey and had at least one office-based visit during that time frame were included in the study sample. Total number and share of ambulatory, preventive, acute, and chronic care visits were calculated and sociodemographic factors associated with a given clinician visit were determined. The outcome variable was type of clinician: primary care physicians (PCPs), internal medicine (IM) subspecialists, and nurse practitioners/physician assistants/registered nurses (NPs/PAs/RNs). The study results were published online Feb. 20 by the Journal of Primary Care & Community Health.
Over the study time frame, visits to PCPs and IM subspecialists declined by 43% and 23% , respectively, while visits to NPs/PAs/RNs increased by 98%. The proportion of preventive care visits provided by PCPs, IM subspecialists, and NPs/PAs/RNs increased by 25%, 7%, and 4%, respectively. Non-White patients had a higher likelihood of seeing PCPs than non-Hispanic White patients, and patients who reported having one chronic condition were more likely to obtain care from an IM subspecialist or NP/PA/RN than a PCP. In contrast, those with two or more chronic conditions were more likely to see a PCP than an NP/PA/RN.
Also, compared to adults ages 18 to 29 years, those 65 years and older had 2.2 times the relative risk of seeing an IM subspecialist than a PCP. Those with less than a high school education were more likely to visit a PCP than an IM subspecialist (relative risk ratio [RRR], 0.9; 95% CI, 0.8 to 1.0), while those with a post-high school education were less likely (RRR, 1.1; 95% CI, 1.0 to 1.2). Patients with higher incomes were less likely to see a PCP than an IM subspecialist (RRR, 1.2; 95% CI, 1.1 to 1.3). Compared to privately insured patients, uninsured patients were 50% more likely to have a PCP visit than an IM subspecialist visit (RRR, 0.5; 95% CI, 0.4 to 0.6).
“An encouraging finding of this study is the increasing number of preventive visits provided by primary care physicians, which is consistent with previous studies,” the authors wrote. “Surprisingly, this trend persisted through the COVID-19 pandemic despite decreasing total visits to primary care physicians from 2020 to 2021. Given that primary care providers are uniquely responsible for providing full-spectrum chronic disease and cancer screening, increasing access to preventive services is essential to improving population health outcomes in the United States.”