Primary Care Providers

Primary Care Providers in California

California

Primary care physicians provide direct patient care and counsel patients on the appropriate use of specialists and advanced treatment options. They are typically the patient’s first point of contact with the health care system and provide critical preventive care, disease management and referrals to specialists. The COVID-19 pandemic has a profound impact on primary care. Many providers have needed to adjust how they provide in-person services and rapidly increased their use of telehealth services.

The United States is currently facing a shortage of physicians due to the nation’s growing health care needs. Having a better or sufficient supply of primary care physicians in a community has numerous benefits, including: 

• Lower rates of infants with low birthweight.
• Lower all-cause mortality and longer life spans.
• Reductions in health system costs.
• Reductions in health disparities.

The number of primary care physicians per 100,000 population is changing due to evolving state populations, physician retirement, new physicians entering the system and physicians changing states and/or specialties. The Health Resources and Services Administration (HRSA) has estimated that, as of October 2022, an additional 17,000 primary medical care providers are necessary to meet current U.S. health care needs in designated health workforce shortage areas. Projections for primary care shortages by 2034 range from 17,800 to 48,000 physicians, mainly due to population growth and aging.

There are documented racial and socioeconomic disparities in access to primary care physicians, which may contribute to disparities in health outcomes. Populations disproportionately affected by lack of access to primary care include:

• Hispanic and non-Hispanic Black adults, who were less likely to have a usual source of care compared with white adults.
• Those living in rural areas compared with those in urban areas.

Racial disparities in access to care have been linked to differences in socioeconomic status, education level and insurance coverage.

Immediate and long-term measures to address the nation’s primary care shortage include: 

• Increasing primary care capacity by empowering licensed personnel, including nurse practitioners and physician assistants, to perform more responsibilities. 
• Increasing federal funding for medical residency training positions.
• Promoting primary care practice among medical residents. 

Increasing diversity within the physician workforce requires addressing barriers throughout students’ education including:

• High-quality education within underserved and underrepresented communities.
• Programs to encourage minority students to pursue medicine as a career.
• College and medical school admissions procedures that allow for the consideration of race and ethnicity.
• Mentorship for minority student in medical school

The effects of increased telehealth use on the demand for primary care providers are uncertain. The U.S. Department of Health and Human Services (HHS) implemented policy changes in response to the COVID-19 public health emergency to make telehealth more accessible. Continuation of those policies may allow more physicians to continue to offer those services.

Regarding rural areas, the Centers for Medicare and Medicaid Services (CMS) has developed the Rural Health Strategy in response to the modern needs of rural Americans. Educational interventions are particularly effective at increasing and retaining a rural health workforce. These include: selecting university students with rural backgrounds, university and post-graduate training in rural locations and supporting further education for qualified rural health professionals. However, more research is needed to address the physician shortage in rural areas.

Healthy People 2030 objectives related to primary care physicians include increasing the proportion of people with a usual primary care provider and reducing the proportion of people who can’t get medical care when needed.

Bodenheimer, Thomas S., and Mark D. Smith. 2013. “Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians.” Health Affairs 32 (11): 1881–86. https://doi.org/10.1377/hlthaff.2013.0234.

Mahmoudi, Elham, and Gail A. Jensen. 2012. “Diverging Racial and Ethnic Disparities in Access to Physician Care: Comparing 2000 and 2007.” Medical Care 50 (4): 327–34. https://doi.org/10.1097/MLR.0b013e318245a111.

Poghosyan, Lusine, Edward J. Timmons, Cilgy M. Abraham, and Grant R. Martsolf. 2019. “The Economic Impact of the Expansion of Nurse Practitioner Scope of Practice for Medicaid.” Journal of Nursing Regulation 10 (1): 15–20. https://doi.org/10.1016/S2155-8256(19)30078-X.

“QuickStats: Percentage of Adults Aged 18–64 Years with a Usual Place for Health Care, by Race/Ethnicity — National Health Interview Survey, United States, 2008 and 2018.” 2020. MMWR. Morbidity and Mortality Weekly Report 69 (5): 147. https://doi.org/10.15585/mmwr.mm6905a6.

Russell, Deborah, Supriya Mathew, Michelle Fitts, Zania Liddle, Lorna Murakami-Gold, Narelle Campbell, Mark Ramjan, et al. 2021. “Interventions for Health Workforce Retention in Rural and Remote Areas: A Systematic Review.” Human Resources for Health 19 (1): 103. https://doi.org/10.1186/s12960-021-00643-7.

Starfield, Barbara, Leiyu Shi, and James Macinko. 2005. “Contribution of Primary Care to Health Systems and Health.” The Milbank Quarterly 83 (3): 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x.