Supply, demand out of balance for primary care, behavioral health in cities across U.S.

Supply and demand are out of balance for primary care physicians (PCPs) and behavioral health providers (BHPs) across the United States, according to a new report that analyzed trends of metropolitan areas.

Meanwhile, at least one forecast predicts the nation needs more of both to avoid a physician shortage in coming years.

But it’s also clear that cities in growth states have fewer PCPs and BHPs right now, while other parts of the country with slower growth rates have more physicians among the population.

Those findings were part of a new report by market consultant Trilliant Health, which used U.S. Census Bureau data to describe mismatches among population hot spots and locations where health care providers are.

“Quantifying the current state of provider supply at the local level is necessary to understand current and future gaps in supply for both primary care and behavioral health services,” said the report by Sanjula Jain, PhD, Trilliant Health chief research officer.

Facing a shortage

The Association of American Medical Colleges’ report, “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034,” has become a cited source for its projection that the United States could have a physician shortage of 37,800 to 124,000 by 2034.

But the situation is not uniform around the nation.

“Understanding what is required to ‘fix’ the provider shortage must begin with identifying which geographies have an oversupply or undersupply of providers by specialty,” the Trilliant Health report said.

Primary care demand

Based on the Census figures, the average rate of PCPs per 100,000 people is 110 for the United States, in metropolitan areas with populations of at least 200,000 people. The report acknowledged contributions of health care workers such as physician assistants and nurse practitioners in primary care, but limited the headcount to board certified physicians.

Demand for primary care decreased during the pandemic, “a function of shifts in patient behaviors rather than a reduction in burden of disease,” the report said. Primary care demand is predicted to grow by 1.4% a year through 2029 overall.

In coming years, growth states such as Idaho, Utah, Texas, Nevada, Arizona, and Florida are projected to see at least a 1.9% increase in primary care service demand through 2029, but those states have many cities with the lowest ratio of PCPs per 100,000 people, the report said. Meanwhile, states such as Massachusetts, Wisconsin, Indiana, and Ohio have projected PCP demand rising 1.2% at most, but have the highest concentration of PCPs.

Behavioral health care

BHPs are spread thinner, with a nationwide average of 61 per 100,000 people, in metropolitan areas with at least 200,000 people, according to the Trilliant Health report. That figure includes psychiatrists, psychologists, behavioral therapists, social workers, and psychiatric nurse practitioners.

As of June, 32.8% of adults were reporting symptoms of anxiety or depression, down from a high of more than 40% during the height of the COVID-19 pandemic.

Although that demand has decreased, there has been increasing attention on integrating behavioral health screening in primary care. The Trilliant Health report noted this month, the U.S. Preventive Services Task Force issued its draft recommendations supporting primary care screening for depression, anxiety, and suicide risk for adults.

Those recommendations underscore “the potential that certain mental and behavioral health conditions are going untreated or undiagnosed, in part due to the nationwide provider shortage,” the report said.

“Despite efforts to better integrate primary care and behavioral health care, how will the screened population, if adopted nationally, be treated given the undersupply of BHPs?” the report said. It called for health care stakeholders to examine consumer behaviors and preferences at a hyperlocal level, and for more analysis to compare demand for PCPs and BHPs in the various markets.