Research Highlights Patient Demand for Primary Care Physicians

Robert Graham Center Tabulates Chronic Care Visits

January 15, 2014 02:35 pm Sheri Porter – Even though 70 percent of U.S. physicians report undergoing subspecialty training that involves specific chronic diseases, such as asthma and diabetes, new research shows that a majority of patients seeking care for most of 14 high-cost chronic conditions examined turn to primary care physicians.

Conducted by researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, the study is summarized in a policy brief( in the January-February issue of the Journal of the American Board of Family Medicine.

Specifically, researchers used data from the 2008 National Ambulatory Medical Care Survey to track outpatient visits for each of 14 high-cost chronic conditions listed by CMS in its Chronic Conditions Dashboard to determine if patients were seen by a primary care physician or a subspecialist.

Primary care physicians were designated as those in family medicine, general practice, internal medicine or pediatrics.

Researchers found that of more than 10 million patient visits for asthma, 85.5 percent were to a primary care physician. For depression, 53.3 percent of visits were to a primary care physician, and for chronic obstructive pulmonary disease, 84.5 percent of visits were to a primary care physician.

Story highlights
  • New research published in the Journal of the American Board of Family Medicine shows that many patients with chronic diseases receive care from primary care physicians.
  • Of the 14 high-cost chronic conditions for which researchers tracked data, more patients sought care from primary care physicians versus subspecialists in all but three disease categories.
  • Researchers noted that patients' dependency on primary care may not be fully appreciated.

In addition, researchers found that primary care physicians handled

  • 66.8 percent of nearly 5 million patient visits for osteoporosis,
  • 50.2 percent of more than 15 million visits for diabetes,
  • 63.6 percent of nearly 25 million visits for chronic kidney disease,
  • 77.9 percent of more than 30 million visits for hyperlipidemia and
  • 68.9 percent of more than 50 million patient visits for hypertension.
In fact, of the 14 chronic conditions for which researchers reviewed data, in only three disease instances -- arthritis, atrial fibrillation and ischemic heart disease -- did patients more often see a subspecialist than a primary care physician.

"These data demonstrate how much patients depend on primary care physicians to take care of these complex and chronic conditions," said Graham Center Director Andrew Bazemore, M.D., M.P.H., in a Jan. 8 press release(

"Many of these patients have multiple chronic conditions, so a physician with expertise in the whole person and the broad range of medical diagnoses is instrumental to ensuring that all their health needs are met," he added.

In the research summary, Bazemore and his colleagues noted that primary care "has been acknowledged as essential to the success of health care reform and the nation's triple aim" (i.e., improving patient care and outcomes and lowering costs).

The researchers added that the degree to which chronically ill patients depend on primary care physicians "may not be fully appreciated," and they suggested that primary care physicians be described as "complex care physicians" given their obligation to not only identify patient needs, but also to oversee preventive services, facilitate behavioral change and coordinate care with other health care professionals.

The findings are particularly relevant to family physicians, according to corresponding author Manisha Sharma, M.D., of Baltimore, medical director of Evergreen Health Care and a visiting scholar at the Graham Center. As a practicing family physician, Sharma is all-too-familiar with the crush of patients seeking care for chronic health conditions.

However, even she was caught off guard by the sheer numbers of patients who sought primary care versus subspecialty care, as well as by the lengthy list of chronic diseases involved.

"It's a large chunk of chronic conditions, and that did surprise me," Sharma told AAFP News Now. She said America's health care paradigm is shifting toward preventive care and interventions, functions that some would call the heart and soul of family medicine.

"Family physicians are the true leaders when it comes to the art of complex care," said Sharma. "We're multi-focused and knowledgeable in many areas of care."

According to Sharma, family physicians -- more than physicians in any other primary care specialty -- are trained to look at social determinants of health, such as the neighborhoods and conditions in which patients live, work and play.

"We need to start looking at the things that are the 'underbelly' of all these chronic conditions and how they are layered one on top of the other," said Sharma. "If we want to have a healthier America as we move forward, I really do believe the conversation needs to shift toward the social determinants of health."

In addition, said Sharma, health care policymakers in the midst of creating new models of care and making important decisions about the care that is delivered would do well to listen to physicians in the trenches.

Primary care physicians and, in particular, family physicians "need to be in the room and at the table," said Sharma. "We need to be part of those conversations, because we know what goes on day-to-day with our patients."

More Medical School Students Opting For Family Medicine Careers, Data Show

September 04, 2013 04:45 pm James Arvantes – The percentage of medical school graduates choosing family medicine residencies has jumped by nearly 10 percent during the past five years, an increase that demonstrates the growing popularity of family medicine as a career choice, according to Perry Pugno, M.D., vice president for medical education at the AAFP.

The AAFP conducts an annual survey of the nation's family medicine residency programs, and according to those data, 67.4 percent of first-year family medicine residents graduated from U.S. allopathic or osteopathic medical schools this year, making 2013 the fifth straight year the percentage has increased. In 2009, 58 percent of first-year family medicine residents graduated from a U.S. allopathic or osteopathic medical school.

"This is another indicator that medical students realize primary care is the foundation of health care," said Pugno in a recent press release. "The number of students choosing family medicine in the annual Match (National Resident Matching Program) continues to increase, and the attendance at the AAFP's National Conference for Family Medicine Residents and Medical Students has really increased. All of these point to a trend toward primary care careers."

Pugno added, however, that the nation is not producing enough family physicians to meet the growing demand for primary care and family physician services, especially as the population ages and more people gain access to health care coverage through the Patient Protection and Affordable Care Act.

The nation is producing about 3,500 family physicians a year, but will need about 40,000 more FPs by 2020 to address current and anticipated demand, said Pugno in an interview with AAFP News Now.

He described medical students as "savvy consumers of information," saying "they recognize that the demand for primary care is clearly going to escalate."

"They see the results of studies from across the nation showing that a robust primary care base achieves better care, better patient experience and better health, and that it does so at a lower cost," said Pugno.

How Health Insurance Reform Proposes to Help Rural Americans

Lower Costs

Preventive Care for Better Health: Health reform will ensure that all Americans have coverage of preventive services.

Ending the Hidden Tax:  Insured families pay a “hidden insurance tax” for the unpaid costs of the 20% of rural families who don’t have insurance by offering affordable insurance.

Financial Relief for Working Families: By ensuring coverage of basic health care services health reform will help rural families with their health care bills.

Family physicians top list of most-recruited specialties in the U.S.
Data from Merritt Hawkins' 2013 Review of Physician and Advanced Practitioner Recruiting Incentives showed family medicine was the most-recruited medical specialty in the U.S., followed by internal medicine. Hospitalist, psychiatry, emergency medicine and pediatrics were also among the top 10. (8/28)

The new class of the Rural Medicine Program was selected on June 6. The students are each from a different area of the state and represent 4 different colleges. OFHER is proud of each one these students and wants to wish them the best as they begin their studies at Auburn University in August.