By: Maria-Paula
A new study led by researchers at Virginia Commonwealth University on Virginia’s neighborhoods and funded by the National Institutes of Health indicate that residents don’t have enough primary care physicians with rural communities being hit hardest by workforce shortages.
The research team findings using anonymized health care claims data, showed that 44% of census tracts in the state lacked adequate access to primary care services, affecting nearly 3.8 million Virginians. The results, published in the Annals of Family Medicine, could help inform workforce interventions in targeting neighborhoods most in need of expanded primary care access.
“Primary care physicians are the foundation of any health care system, with the ability to provide care across the spectrum of people’s lives. Not only do they help treat acute medical problems, they also play an important role in helping patients manage chronic health issues like diabetes and hypertension,” said Hannah Shadowen, Ph.D., an M.D.-Ph.D. student at VCU’s School of Medicine and School of Public Health and lead author of the new study. “
Estimates from the Association of American Medical Colleges indicate that by 2032 the United States will be short by more than 55,000 primary care physicians in meeting its citizens health care needs, therefore pushing residents to sought the services elsewhere or have no such care at all. Such deterioration in health care workforce and a shortage in primary care physicians can only mean inadequate access to primary care results in more hospitalizations and emergency department visits, shorter lifespans and greater health inequities for communities.
“In order to develop interventions that effectively address primary care shortages, we need to better understand which communities are facing the biggest barriers to access,” said Alex Krist, M.D., a professor in the VCU School of Medicine’s Department of Family Medicine and Population Health and one of the study’s co-authors.
According to 2019 data,  4,850 physicians provided primary care services with each seeing 1,368 patients on average. 44% of Virginia’s census tracts therefore, did not have adequate access to primary care physicians.
Through the Virginia All-Payer Claims Database, Krist, Shadowen and their colleagues determined the number of physicians actively providing primary care in Virginia, the locations of their practices and the number of patients seen by each physician. The researchers also included obstetrician-gynaecologists, internal medicine physicians and paediatricians seen by patients for wellness visits.
In addition to considering other demographic factors including age, insurance coverage, income level, medical needs, disability rates, education level, rurality, and racial and economic segregation, the researchers also calculated primary care provider deficiencies. The total patient capacity of all physicians within a 30-minute drive of each census tract was compared to the census tract’s population size.
“While some studies estimate how many patients a provider should be able to see annually, this data really speaks to the actual capacity of each provider and the type of care they can give to the community,” Shadowen said. “Rather than giving a prediction on health care shortages, this data provides a realistic depiction of the primary care workforce in Virginia and where the shortages are felt most prominently.”
Structural and geographic factors also came out as the strongest predictors of whether a community had enough primary care physicians in Virginia. In particular, rural communities experienced significantly less primary care access compared with suburban or urban neighborhoods. On average, the primary care capacity of rural census tracts was approximately 725 patients lesser than in suburban tracts.
“The researchers also found that census tracts with higher proportions of Black residents had greater access to primary care services than those with predominantly white residents since most Black neighborhoods in Virginia tend to be in urban areas explains why typically have a greater number of primary care physicians,” Shadowen said. “These trends could also be the result of local and national efforts to address the health needs of historically marginalized neighborhoods, such as Federally Qualified Health Centers and pathway programs.”
The researchers findings show that more work needs to be done to increase Virginia’s rural primary care workforce by expanding residency programs in rural settings or establishing incentive programs like loan repayment benefits which could potentially help with closing these gaps in health care access. They also noted that having access to primary care does not always mean that these services are being utilized.
Their next studies are focused on better understanding how access to care influences the likelihood of seeing a primary care physician in Virginia.
Shadowen and Krist conducted this study alongside researchers from VCU’s School of Medicine and School of Public Health: Jennifer L. Gilbert, Psy.D.; Benjamin Webel; Jong Hyung Lee, Ph.D.; Scott M. Strayer, M.D.; Jacqueline B. Britz, M.D.; Adam Funk; Roy T. Sabo, Ph.D.; and Andrew J. Barnes, Ph.D. They also collaborated with Lauryn S. Walker, Ph.D., from the Virginia Center for Health Innovation; Michael Topmiller, Ph.D., from HealthLandscape; and Andrew Mitchell, Ph.D., from the Virginia Department of Medical Assistance Services.