To further inform policy discussions around the U.S. primary care workforce, the Agency for Healthcare Research and Quality (AHRQ) is producing a set of fact sheets to provide health care policy and decisionmakers with information on the U.S. primary care workforce.
The Primary Care Workforce in the United States
To further inform policy discussions around the U.S. primary care workforce, the Center for Primary Care, Prevention, and Clinical Partnerships of AHRQ is producing a set of fact sheets to provide health care policy and decisionmakers with information on:
- The primary care workforce in place currently in the U.S.
- Its capacity to care for the current U.S. population.
- Needed growth in this workforce to accommodate population changes and expanded health care insurance coverage.
AHRQ commissioned the Robert Graham Center, a non-partisan primary care policy and analysis organization, to conduct a comprehensive primary care workforce analysis that included secondary analysis of several workforce, population, and health outcome data sources. The Graham Center used additional data to make needed adjustments to these data and used geospatial analyses to study relationships between the primary care workforce and population health outcomes. They also used population and utilization growth estimates based on typical demographic projections and expected health insurance expansion to estimate future demand for care.
AHRQ uses the Institute of Medicine's 1996 definition of primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community."1
Primary care is a foundational element of the U.S. health care system and is required to meet our Nation's triple aims of improving quality, containing costs, and improving patient and family experience. Primary care is also critical to ensuring access to health care for all Americans and reducing health care disparities. Whether the focus is on the individual, a population, or the health care system, good access to primary care is associated with more timely care, better preventive care, avoiding unnecessary care, improved costs, and lower mortality.2
Primary care by some measures is the largest aspect of our health care system. In 2008, 490 million visits were made to primary care physicians—a bit more than half of all visits to physicians' offices.3 But primary care's share of visits has been declining.
The U.S. primary care system is struggling under increasing demands and expectations, diminishing economic margins, and increasing workforce attrition compounded by diminishing recruitment of new physicians, nurses, and physician assistants into primary care.4 Approximately one-third of physicians currently practice in primary care but fewer than one-fourth of current medical school graduates are going into primary care. The Council on Graduate Medical Education is concerned that the trend, if unchecked, will progress to fewer than one-fifth of medical students specializing in primary care.5
To create a sound health care system built on a strong foundation of primary care, the U.S. requires a skilled primary care workforce. Significant recent Federal efforts have been made to address the needs of the primary care workforce. In 2010, the United States invested $250 million from the Affordable Care Act's Prevention and Public Health Fund in primary care professional training.
U.S. Primary Care Workforce Facts and Stats Series
- The Number of Practicing Primary Care Physicians in the U.S.
In 2010, there were approximately 209,000 practicing primary care physicians in the United States.
- The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the U.S.
In 2010, approximately 56,000 nurse practitioners and 30,000 physician assistants were practicing primary care in the U.S.
- The Distribution of the U.S. Primary Care Workforce
Primary care physicians, nurse practitioners, and physician assistants are more likely to practice in rural areas than are non-primary care specialists, but are still more concentrated in urban areas.
During the coming months, AHRQ will release several more Primary Care Workforce Fact Sheets examining topics such as:
- Mapping the Distribution of the U.S. Primary Care Workforce.
- Quality and the Population-to-Primary-Care Professional Ratio.
- Primary Care Workforce Needs Due to Health Reform, Population Growth, and Demographic Change.
1. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, Editors. Primary Care: America's Health in a New Era. Committee on the Future of Primary Care, Division of Health Care Services. Institute of Medicine. National Academy Press. Washington, D.C. 1996: p. 31.