Communities With More Primary Care Docs Have Lower Mortality

A greater primary care physician supply was associated with lower mortality, but the per capita supply did not keep pace with U.S. population growth between 2005 and 2015.

Every 10 additional primary care physicians per 100,000 population was associated with a 51.5 day increase in life expectancy, according to a study published Monday in JAMA Internal Medicine.

Using that same metric, an increase in 10 specialist physicians per 100,000 population corresponded to a 19.2-day increase in life expectancy, the study found.

By linking mortality rates with the numbers of primary care physicians, the Stanford University research supports the validity of population health initiatives that emphasize and rely upon access to primary care.

Over the course or a decade, the primary care physician supply in the U.S. increased from 196,014 in 2005, to 204,419 in 2015. That number did not, however, keep pace with the overall population growth, which means the number of primary care physicians per capita in that span decreased from 46.6 per 100,000 population to 41.6 per 100,000.

Furthermore, the study found "disproportionate losses" of primary care physicians in some counties, particularly in rural areas.

"The authors suggest the decrease in primary care physician supply across counties could have important health implications, although conclusions about individual-level effects shouldn't be drawn from population-level associations," the study said.

In a commentary accompanying the study, Sondra Zabar, MD, Andrew Wallach, MD, and Adina Kalet, MD, said more must be done both to steer physicians in training toward primary care, particularly in underserved areas.

"To increase access to primary care, especially in underserved areas, we must align incentives to attract individuals into primary care practice, innovate primary care training, and greatly improve the primary care practice model," the physicians wrote. "Physician payment reform is a key to making all of this happen."

"Our reimbursement system needs to incentivize a realignment in the ratio between primary care and non-primary care that is associated with the best population health, such that primary care physicians no longer shoulder a disproportionate share of administrative work such as medication refills and prior authorizations," the physicians wrote.

The study looked at U.S. population data and individual-level claims data linked to mortality from 2005 to 2015 against changes in primary care and specialist physician supply from 2005 to 2015.

Data from 3,142 counties, 7,144 primary care service areas, and 306 hospital referral regions were used to investigate the association of primary care physician supply with changes in life expectancy and cause-specific mortality after adjustment for healthcare, demographic, socioeconomic, and behavioral covariates.