Projecting the Supply and Demand for Primary Care Practitioners Through 2020
If the system for delivering primary care in 2020 were to remain fundamentally the same as today, there will be a projected shortage of 20,400 primary care physicians. Under a scenario in which primary care nurse practitioners (NPs) and physician assistants (PAs) are fully integrated into health care delivery, such as patient-centered medical homes that emphasize team-based care, the projected shortage of primary care practitioners in 2020 could be somewhat alleviated. This study provides national averages and does not account for workforce distribution; some areas of the country will likely continue to have a supply of primary care practitioners well above the national average, while the supply of primary care practitioners in other areas will likely continue to be below the national average. Demand for primary care services is projected to increase through 2020, largely because of aging and population growth and, to a much lesser extent, from expanded insurance coverage as the Affordable Care Act is fully implemented. The Affordable Care Act includes a number of investments and incentives to increase the supply and improve the distribution of primary care practitioners (PCPs), as well as transform the health care delivery system.
Demand for primary care services is projected to grow, mostly due to population aging and growth.
- Aging and population growth are projected to account for 81 percent of the change in demand between 2010 and 2020.
- The remainder of the projected change in demand is associated with the estimated expansion of health insurance coverage under full implementation of the Affordable Care Act, including an assumption that all states expand Medicaid.
Based on current utilization patterns, demand for primary care physicians is projected to grow more rapidly than physician supply.
- The number of primary care physicians is projected to increase from 205,000 FTEs in 2010 to 220,800 FTEs in 2020, an 8-percent increase.
- The total demand for primary care physicians is projected to grow by 28,700, from 212,500 FTEs in 2010 to 241,200 FTEs in 2020, a 14-percent increase.
- Without changes to how primary care is delivered, the growth in primary care physician supply will not be adequate to meet demand in 2020, with a projected shortage of 20,400physicians. While this deficit is not as large as has been found in prior studies, the projected shortage of primary care physicians is still significant.
The primary care NP and PA workforces are projected to grow far more rapidly than the physician supply.
- The supply of primary care NPs is projected to increase by 30 percent, from 55,400 in2010 to 72,100 in 2020. The supply of primary care PAs is projected to increase by 58 percent, from 27,700 to 43,900 over the same period.
- Assuming that NPs and PAs provide the same proportion of services in 2020 that they did in 2010, the combined demand for NPs and PAs would increase by only 17 percent. If NPs and PAs are used to provide a greater proportion of primary care services, their projected demand will be higher.
Increased use of NPs and PAs could somewhat alleviate the projected primary care physician shortage if they are effectively integrated into the health care delivery system.
- Under a scenario in which the rapidly growing NP and PA supply can effectively be integrated, the shortage of 20,400 physicians in 2020 could be reduced to 6,400 PCPs.
- If fully utilized, the percent of primary care services provided by NPs and PAs will grow from 23 percent in 2010 to 28 percent in 2020. Physicians would remain the dominant providers of primary care, only decreasing from 77 percent of the primary care services in 2010 to 72 percent in 2020.