Primary Care Trends in 2023
The backbone of healthcare delivery, primary care physicians serve as a major access point for patients receiving the care they need. Yet the medical landscape is changing, affecting practitioners and patients alike.
“I am optimistic about the future of primary care, mostly because we are still attracting the best and brightest to medical schools,” said David Nash, MD, MBA, founding dean emeritus and the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health in Philadelphia.
Nash reported that organizations like Walmart, Walgreens, Amazon, and CVS are changing the primary care landscape. Primary care physicians in private practice are on the decline, including those in family and internal medicine. More physicians are employed or seeking other external support, including private equity investment, as crises such as the COVID-19 pandemic have shuttered offices.
Challenges in primary care
“Primary care is a key foundation of our health care system,” said Tochi Iroku-Malize, MD, MPH, MBA, FAAFP, president of the American Academy of Family Physicians (AAFP). “However, a new scorecard authored by the Robert Graham Center found that the United States is systemically underinvesting in primary care.”
Family physicians provide whole-person comprehensive health care for people of all ages — from newborns to seniors, she added. Many times, primary care physicians are the only ones providing care, particularly in rural and underserved areas, adapting care to fill the needs of these communities.
“Primary care is critical to meet the growing, diverse needs of our patient population,” Iroku-Malize added. “Primary care accounts for 35 percent of healthcare visits but receives only about five to seven percent of total healthcare expenditures.”
And that is part of the problem with primary care practice.
“Primary care work is sadly undervalued,” Nash said. “The legacy of the RVU [(relative value unit)] payment system has contributed mightily to the downfall of primary care.”
Salaries for primary care physicians remain below many specialties, reported Medscape’s 2022 Physician Compensation Report, with family medicine physicians earning on average $255,000 annually and internal medicine physicians $264,000 annually, as compared to plastic surgeons at $576,000 annually.
Nash indicated most medical students understand these economics and reward systems and opt for other fields.
Current trends in primary care
“Primary care – and family medicine, in particular – is vital to ensuring patient health, preventing complications of chronic conditions, improving patient outcomes, reducing unnecessary spending, and providing an equitable distribution of healthcare in the community,” Iroku-Malize said.
The use of telehealth is a primary care trend in 2023, with a market size in the United States of $30.4 billion in revenue. Telehealth has gained recognition as improving the timeliness of delivering primary care and offsetting financial losses, according to an April 2023 report from The Commonwealth Fund.
“Many of those who have left physical health practices have transitioned into telemedicine and independent remote roles,” said Nancy Mitchell, RN, of Atlanta. “The need for a more flexible workforce extends to healthcare providers as well. Countless physicians are taking a step back from long lines in the waiting room to attend to patients online in more relaxed settings that give them more freedom with their working hours.”
More patients are using wearable devices, such as the Apple Watch, which has been approved as a medical device by the Food and Drug Administration. Physicians and advanced practitioners in primary care often must educate patients about the proper use of devices to monitor heart rates and collect other health data.
Major retailers have entered the primary care market in big ways. Amazon purchased One Medical and CVS Oak Street Health.
“Mergers and acquisitions will create an appetite for additional primary care doctors,” Nash said. While some retail outlets will likely continue to employ mostly nurse practitioners, “physicians will serve as medical directors and leaders of primary care.”
Nash said newly educated physicians must learn how to thrive in these new environments.
“A handful of new medical schools are doing a pretty good job at looking at the environment and saying we need some new training models for these new environments,” Nash said. “It is happening slowly.”
But new schools are not burdened by history, Nash explained, and can place students into Federally Qualified Health Centers, retail clinics, and other places to better prepare them for primary care practice in the future.
Health systems and private practices across the country have a number of jobs available in primary care, including locum tenens assignments for physicians, nurse practitioners, and physician assistants. While demand varies by state and region, locum assignments help to place qualified practitioners where they are needed most.
Supply and demand for primary care physicians
“The primary care physician shortage is a complex issue affected by growing demand, a history of under-investment in primary care, an aging physician workforce, and economic pressures on the rural health system,” Iroku-Malize said. “It is estimated that we will need up to 48,000 additional primary care physicians by 2034.”
That statistic comes from the Association of American Medical Colleges. A large number of physician retirements is another contributing factor to the country’s primary care physician shortage.
According to the Graham Center Scorecard, the number of working primary care physicians is declining and difficulties accessing care are growing. Fewer adults have a usual source of care than in 2010. And only 20 percent to 21 percent of all physicians finishing up residency programs, from 2012 to 2020, were practicing primary care two years later.
On a positive note, primary care trends in 2023 include more medical school graduates choosing to work in primary care. The family medicine class of new residents on the May 2023 Match Day was the largest in history, with 4,530 matching into family medicine residency programs, AAFP reported. The American College of Physicians reported 9,345 internal medicine residency positions were filled.
Advanced practitioners and team-based care
Advanced practitioners are in great demand. The U.S. Bureau of Labor Statistics reports nurse practitioners (NPs) are the fastest-growing profession in the nation, with employment expected to increase by 45.7 percent by 2031. The agency reports physician assistant (PA) employment will grow by 27.7 percent.
Among the healthcare trends in 2023, NPs and PAs are taking on more responsibilities in primary care. Twenty-six states have granted nurse practitioners full practice authority.
“As more physicians retire from the profession, we’re seeing more primary care practices recruiting nurse practitioners and physician assistants to accommodate the demand for health services,” Mitchell said. “The dwindling physician population doesn’t equate to a decline in the need for healthcare providers. In fact, it’s made it more challenging for physicians to manage their workloads. The call for nurse practitioners and assistants is meant to help them handle the increasing need for care providers in physical settings.”
“AAFP believes that all health professionals should work together as multidisciplinary, integrated teams in the best interest of patients,” Iroku-Malize said. “The AAFP recognizes nonphysician providers (NPPs) as an integral part of physician-led healthcare teams. However, NPPs are not a substitute for physicians, especially when it comes to diagnosing complex medical conditions, developing comprehensive treatment plans, ensuring that procedures are properly performed, and managing highly involved and complicated patient cases.”
Team-based care also includes care managers in primary care offices, but primary care physicians have not been taught about teamwork, Nash said.
Tips for landing a primary care job
“I encourage the next generation of physicians to consider primary care, and in particular, family medicine,” Iroku-Malize said. ”The best part of family medicine is that you get to treat people for most of all their healthcare needs on an ongoing basis.”
Iroku-Malize recommended to medical school graduates to “Do your research, find a family physician mentor, and check out aafp.org for resources to help you on your journey to primary care.”
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