Primary care physician numbers down as other clinicians increase from 2016 to 2021

© MedPAC

The latest data from Medicare show how the number of primary care physicians is shrinking, but a growing number of advanced practice registered nurses and physician assistants.

It appeared the COVID-19 pandemic also caused some changes to health care workforce measures in 2020.

The facts, figures, and findings were part of the 200-page “Health Care Spending and the Medicare Program,” the July 2023 data book from the Medicare Payment Advisory Commission (MedPAC). The commission announced the publication on July 31, following reports earlier this year that have prompted public discourse about physician payment and site-neutral reimbursement.

Primary care and the rest

From 2016 to 2021, the number of primary care physicians billing Medicare declined each year, from 142,000 physicians in 2016 to 135,000 physicians in 2021. Based on primary care physicians per 1,000 beneficiaries, the number dropped from 2.7 in 2016 to 2.3 in 2021.

At the same time, other specialties, APRNs and PAs, and other practitioners all increased:

• Other specialties: 446,000 in 2016 to 471,000 in 2021.
• APRNs and PAs: 198,000 in 2016 to 286,000 in 2021.
• Other practitioners: 162,000 in 2016 to 180,000 in 2021.

Measuring those groups based on 1,000 beneficiaries, APRNs and PAs grew from 3.8 to 4.9 from 2016 to 2021. Other specialties decreased from 8.6 to 9.1, while other practitioners were stable at 3.1 for that period.

The report noted primary care includes family medicine, internal medicine, pediatrics and geriatrics. Hospitalists are included in other specialties, while other practitioners includes clinicians such as physical therapists, psychologists, social workers, and podiatrists.

Patient encounters

A similar trend was noticeable in patient encounters, which measure beneficiary interactions with clinicians. Those increased overall from 2016 to 2021.

Primary care physician encounters per beneficiary dipped from 3.8 in 2016 to 3.2 in 2021, for a cumulative decrease of 16.1%. Specialist encounters fell from 12.7 to 12.3, a cumulative decrease of 3.7%.

Meanwhile, encounters per beneficiary rose from 1.8 to 2.7 for APRNs and PAs, making a cumulative increase of 51.7%. Other practitioners saw encounters rise from 3.1 in 2016 to 3.5 in 2021, for a cumulative increase of 11.9%.

“These changes continue a longer-term trend of declines in services billed by primary care physicians and rapid increases in services billed by APRNs and PAs,” the report said.

“The decline in encounters with primary care physicians occurred across a broad range of services, including evaluation and management services, tests, procedures, and imaging services,” although that data was not included in the report.

Telehealth

In the past 12 months, 35% of beneficiaries reported having a video or telephone visit with any type of health care provider. Among them, 54% said they were very satisfied and 38% said they were somewhat satisfied with telehealth appointments and 42% said they would be interested in continuing telehealth visits after the COVID-19 pandemic ends, according to the report.

Medicare spending

“Medicare was the largest single purchaser of personal health care in the U.S.” in 2021, accounting for 24% of health care spending that totaled $3.6 trillion. Private health insurance covered 31% of that total; that was greater than Medicare’s share, but the report noted private health insurance is a category with many plans, not a single purchaser.

For the total, Medicaid paid 18%, out-of-pocket costs were 12%, other third-party payers were 11%, and federal programs such as the U.S. Department of Veterans Affairs was 5%.

For the total figure, in 2020 health care spending hit $3.1 trillion, or 19.7% of the nation’s gross domestic product (GDP), largely due to federal government relief efforts in the COVID-19 pandemic. The 2021 total represents 18.3% of the GDP, which was larger than the 2019 share of GDP.

“One of the drivers of Medicare spending growth between now and 2030 is the continued aging of the baby-boom generation into the Medicare program,” the report said. “By 2030, all baby boomers will have reached Medicare’s age of eligibility.”

MedPAC and the U.S. Congressional Budget Office estimate Medicare will spend $1 trillion this year. MedPAC expects Medicare spending to increase an average of 7.5% a year for the next 10 years, doubling from 2022 to 2032.