This analysis addresses the question, Would increasing the number of primary care physicians improve health outcomes in the United States? A search of the PubMed database for articles containing “primary care physician supply” or “primary care supply” in the title, published between 1985 and 2005, identified 17 studies, and 10 met all inclusion criteria. Results were reanalyzed to assess primary care effect size and the predicted effect on health outcomes of a one-unit increase in primary care physicians per 10,000 population. Primary care physician supply was associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year (1980–1995) or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.
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References
1.
Council on Graduate Medical Education. Third Report: Improving Access to Health Care Through Physician Workforce Reform. Washington, DC, 1992. www.cogme.gov/rpt3.htm.
2.
WeinerJ.Forecasting the effects of health reform on US physician workforce requirement: Evidence from HMO staffing patterns. JAMA272:222–230, 1994.
3.
CopperR. A.Weighing the evidence for expanding physician supply. Ann. Intern. Med.141:705–714, 2004.
4.
Council on Graduate Medical Education. Summary Report to Congress and Secretary Department of Health and Human Services. Washington, DC, June 2002. www.cogme.gov/2002summary.htm.
5.
JoinesJ. D.A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina. Soc. Sci. Med.56:2541–2553, 2003.
6.
VogelR. L.AckermannR. J.Is primary care physician supply correlated with health outcomes?Int. J. Health Serv. 28:183–196, 1998.
7.
LaditkaJ. N.Physician supply, physician diversity, and outcomes of primary health care for older persons in the United States. Health Place10:231–244, 2004.
8.
ParchmanM.CullerS.Primary care physicians and avoidable hospitalization. J. Fam. Practice39:123–128, 1994.
9.
ParchmanM. L.CullerS. D.Preventable hospitalizations in primary care shortage areas: An analysis of vulnerable Medicare beneficiaries. Arch. Fam. Med.8:487–491, 1999.
10.
RickettsT. C.Hospitalization rates as indicators of access to primary care. Health Place7:27–38, 2001.
11.
SchreiberS.ZielinskiT.The meaning of ambulatory care sensitive admissions: Urban and rural perspectives. J. Rural Health13:276–284, 1994.
12.
ShiL.The relationship between primary care, income inequality, and mortality in US States, 1980–1995. J. Am. Board Fam. Pract.16:412–422, 2003.
13.
ShiL.Income inequality, primary care, and health indicators. J. Fam. Pract.48:275–284, 1999.
14.
ShiL.Primary care, race, and mortality in US states. Soc. Sci. Med.61:65–75, 2005.
15.
ShiL.Primary care, infant mortality, and low birth weight in the states of the USA. J. Epidemiol. Community Health58:374–380, 2004.
16.
ShiL.Primary care, income inequality, and stroke mortality in the United States: A longitudinal analysis, 1985–1995. Stroke34:1958–1964, 2003.
17.
ShiL.Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties, 1990. Am. J. Public Health95:674–680, 2005.
18.
ShiL.Primary care, social inequalities, and all-cause, heart disease, and cancer mortality in US counties: A comparison of urban and rural areas. Public Health, 2006, in press.
19.
ShiL.StarfieldB.The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas. Am. J. Public Health91:1246–1250, 2001.
20.
ShiL.Primary care, self-rated health, and reductions in social disparities in health. Health Serv. Res.37:529–550, 2002.
21.
ShiL.StarfieldB.Primary care, income inequalities, and self-rated health in the United States: A mixed-level analysis. Int. J. Health Serv. 30:541–555, 2000.
22.
U.S. Centers for Disease Control and Prevention. Health status indicators: Definitions and national data. Statistical Notes1:1–8, 1992.
23.
StarfieldB.The effects of specialist supply on populations' health: Assessing the evidence. Health Aff. (Millwood)Suppl. Web exclusives: W5-97-107, 2005.
24.
ForrestC. B.WhelanE. M.Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices. JAMA284:2077–2083, 2000.
25.
ShiL.America's health centers: Reducing racial and ethnic disparities in perinatal care and birth outcomes. Health Serv. Res.39(6, pt. 1):1881–1901, 2004.
26.
MacinkoJ.StarfiedB.ShiL.The contribution of primary care systems to health outcomes within OECD countries, 1970–1998. Health Serv. Res.38:819–853, 2003.
27.
StarfieldB.ShiL.Policy relevant determinants of health: An international perspective. Health Policy60:201–216, 2002.
28.
VillalbiJ. R.Evaluacion del impacto de la reforma de la atencion primaria sobre la salud. Atencion primaria24:468–474, 1999.
29.
GullifordM. C.Availability of primary care doctors and population health in England: Is there an association?J. Public Health Med. 24:252–254, 2002.
30.
SaverB.Financing and organization findings brief. Acad. Res. Health Care Policy5:1–2, 2002.
31.
FerranteJ. M.Effects of physician supply on early detection of breast cancer. J. Am. Board Fam. Pract.13:408–414, 2000.
32.
DavidsonP. L.Role of community risk factors and resources on breast carcinoma stage at diagnosis. Cancer103(5), 2005.
33.
RoetzheimR. G.The effects of physician supply on the early detection of colorectal cancer. J. Fam. Pract.48:850–858, 1999.
34.
CampbellR. J.Cervical cancer rates and the supply of primary care physicians in Florida. Fam. Med.35:60–64, 2003.
35.
RoetzheimR. G.Increasing supplies of dermatologists and family physicians are associated with earlier stage of melanoma detection. J. Am. Acad. Dermatol.43(2, pt. 1):211–218, 2000.
36.
Van DurmeD. J.Effects of physician supply on melanoma incidence and mortality in Florida. South. Med. J.96:656–660, 2003.
37.
SchappertS. M.National Ambulatory Medical Care Survey: 1992 summary. Adv. Data253:1–20, 1994.
38.
BindmanA.Primary care and receipt of preventive services. J. Gen. Intern. Med.11:269–276, 1996.
39.
PerrinJ. M.Primary care involvement among hospitalized children. Arch. Pediatr. Adolesc. Med.150:479–486, 1996.
40.
RyanS.The effects of regular source of care and health need on medical care use among rural adolescents. Arch. Pediatr. Adolesc. Med.155:184–190, 2001.
41.
RosenblattR. A.The effect of the doctor-patient relationship on emergency department use among the elderly. Am. J. Public Health90:97–102, 2000.
42.
GillJ. M.MainousA. G.3rdNserekoM.The effect of continuity of care on emergency department use. Arch. Fam. Med.9:333–338, 2000.
43.
WeissL. J.BlusteinJ.Faithful patients: The effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am. J. Public Health86:1742–1747, 1996.
44.
GrumbachK.VranizanK.BindmanA.Physician supply and access to care in urban communities. Health Aff. (Millwood)16:71–86, 1997.
45.
HendryxM. S.Access to health care and community social capital. Health Serv. Res.37:87–103, 2002.
46.
WeinerJ. P.Prepaid group practice staffing and U.S. physician supply: Lessons for workforce policy. Health Aff. (Millwood), Suppl. Web exclusives: W4-43-59, 2004.
