There is little debate over the importance of primary care physicians — the virtual quarterbacks on our medical teams running us toward the end zones in good health.
New research now shows us just how important those primary care physicians are in what to many is the most important contest of all: prolonging our lives.
Every 10 additional primary care physicians per 100,000 people in the United States was associated with a 51.5-day increase in life expectancy during the decade from 2005 to 2015, according to a study in JAMA Internal Medicine.
By comparison, the researchers found that an increase in 10 specialist physicians per 100,000 corresponded to just a 19.2-day increase.
“Greater PCP supply was associated with improved population mortality, suggesting that observed decreases in PCP supply may have important consequences for population health,” says Stanford Health Policy’s Sanjay Basu, MD, PhD, the lead author of the study.
“Primary care physicians serve as the primary point of contact for most of the population and often perform preventive care, cancer screening, and early diagnosis,” Basu — himself a primary care physician and epidemiologist — told me in an interview for a press release.
The researchers found that while the number of primary care physicians has increased, the density of PCPs per 100,000 population has decreased from 46.6 to 41.4 per 100,000 people in that same decade due to disproportionate rural losses of physicians and general population size increases.
The Association of American Medical Colleges estimates the United States is expected to see a dramatic shortfall of primary care physicians by 2030.
“Many believe that a well-functioning health care system requires a solid foundation of primary care,” the authors wrote. “Yet, persistent payment disparities between primary care and procedural specialties continue to erode the U.S. PCP workforce.”
The researchers note that the lack of health care policies targeted to increase primary care physician supply, compounded by market forces, have reduced the PCP supply relative to higher-income specialties such as cardiology and orthopedic surgery.
“There are few incentives to go into primary care among U.S. medical school graduates,” Basu said. “Pay tends to be lower, burnout rates higher, and prestige lower.”
The researchers set out to identify the extent to which the number of primary care physicians might impact mortality — and encourage policymakers to consider the importance of getting more PCPs out into the field.
They defined primary care physicians as non-federally employed physicians younger than 75 years old who are not hospital residents and whose major professional activity is outpatient care in general practice, family medicine, general internal medicine, and general pediatrics in each U.S. county and the District of Columbia, or 3,142 counties.
Five major causes of death were considered: cardiovascular disease, cancer, infectious disease, respiratory disease, and substance abuse or violence (such as death from alcohol and drug use, self-harm and interpersonal violence.)
And breaking that down to cause-specific mortality, the researchers found an increase of 10 PCPs per 100,000 people was associated with a reduction in cardiovascular mortality by 0.9 percent; cancer mortality by a 1 percent reduction and respiratory mortality a 1.4 percent decline.
And yet, the number of primary care physicians per capita continues to decline.
“The surprising result was how much PCP supply has declined despite so much emphasis on primary care over the last decade,” said Basu. “I think the problem comes down to money. We pay less for prevention than treatment — and the former is where primary care lives.”
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