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Background:
Prior studies have reported that greater numbers of primary care physicians (PCPs) per population are associated with reduced population mortality, but the effect of increasing PCP density in areas of low density is poorly understood.
Objective:
To estimate how alleviating PCP shortages might change life expectancy and mortality.
Design:
Generalized additive models, mixed-effects models, and generalized estimating equations.
Setting:
3104 U.S. counties from 2010 to 2017.
Participants:
Children and adults.
Measurements:
Age-adjusted life expectancy; all-cause mortality; and mortality due to cardiovascular disease, cancer, infectious disease, respiratory disease, and substance use or injury.
Results:
Persons living in counties with less than 1 physician per 3500 persons in 2017 had a mean life expectancy that was 310.9 days shorter than for persons living in counties above that threshold. In the low-density counties (n = 1218), increasing the density of PCPs above the 1:3500 threshold would be expected to increase mean life expectancy by 22.4 days (median, 19.4 days [95% CI, 0.9 to 45.6 days]), and all such counties would require 17 651 more physicians, or about 14.5 more physicians per shortage county. If counties with less than 1 physician per 1500 persons (n = 2636) were to reach the 1:1500 threshold, life expectancy would be expected to increase by 56.3 days (median, 55.6 days [CI, 4.2 to 105.6 days]), and all such counties would require 95 754 more physicians, or about 36.3 more physicians per shortage county.
Limitation:
Some projections are based on extrapolations of the actual data.
Conclusion:
In counties with fewer PCPs per population, increases in PCP density would be expected to substantially improve life expectancy.
Primary Funding Source:
None.
With the digitization of everything from videos to voices and documents, artificial intelligence and machine learning (AI/ML) have revolutionized industries, including medicine, but have yet to transform primary care. A review of primary care AI/ML concluded that the field remains in “early stages of maturity,” despite a history spanning nearly 35 years.1 Only 1 out of every 7 of these papers includes a primary care author; therefore, one barrier to greater impact is engagement from the primary care community.
Bob Phillips, MD, MSPH
Executive Director of the Center for Professionalism & Value in Health Care, American Board of Family Medicine
Why are you passionate about primary care?
I fell in love with primary care in medical school because I recognized the power of relationships in health. Figuring out what is at the heart of people’s health concerns takes time and trust, and changing unhealthy behaviors can take even longer, but primary care can accomplish both when done well. I want the next generation of primary care clinicians to understand the power of what they can accomplish if they resist making health care transactional—and how taking ownership of relationships changes us too. We also need to help policymakers—both in the government and our health system—understand the value of relationships too and not just how primary care can reduce costs but how we can improve outcomes.