Does Physician Presence Affect Community Mortality?

Areas of the country with more primary care physicians (PCPs) have decreased mortality rates, according to a recent analysis.

“Recent US health care reforms incentivize improved population health outcomes and primary care functions,” the study authors wrote in JAMA Internal Medicine. “It remains unclear how much improving primary care physician supply can improve population health, independent of other health care and socioeconomic factors.”

The study analyzed population and individual-level claims data associated with mortality spanning 2005–2015 against primary care and specialist physician supply changes during the same time period. The data spanned 3,142 counties, 7,144 primary care service areas, and 306 hospital referral regions.

PCP and Specialist Density Changes, Life Expectancy Correlation

Between 2005 and 2015, PCP supply increased from 196,014 to 204,419. However, when considering population increases and PCP losses in certain areas—particularly rural ones—the mean PCP density relative to population size went down, from 46.6 per 100,000 population (95% CI, 0.0–114.6 per 100,000 population) to 41.4 per 100,000 population (95% CI, 0.0–108.6 per 100,000 population). During the study period, the number of specialists increased from 699,989 to 805,277—increasing from 68 per 100,000 population to 71.3 per 100,000 population. Counties gained a mean 3.4 specialists over the study period.

Adjusted mixed-effects regressions revealed that for every 10 more PCPs per 100,000 population, life expectancy increased by a mean 51.5 days (95% CI, 29.5–73.5 days; 0.2% increase); 10 additional PCPs per 100,000 population was also correlated with reduced cardiovascular, cancer, and respiratory mortality by about 1%. With every 10 additional specialists per 100,000 population, life expectancy increased by 19.2 days (95% CI, 7.0–31.3 days).

When breaking down cause-specific mortality and adjusting for covariates, every 10 PCP-increase per 100,000 population reduced cardiovascular mortality by 30.4 deaths per million (95% CI, –52.4 to–8.4; a 0.9% reduction), cancer mortality by 23.6 deaths per million (95% CI, –35.0 to –12.3 deaths per million; 1.0% reduction), and respiratory mortality by 8.8 deaths per million (95% CI, –15.3 to –2.2 deaths per million; a 1.4% reduction). Cardiologist presence significantly decreased the odds of cardiovascular mortality (increase of 10 cardiologists associated with –49.4 deaths per million [95% CI, –76.8 to –22.0 deaths per million]), and an increase in pulmonologists greatly reduced respiratory tract disease mortality (10 pulmonologists associated with –10.5 deaths per million [95% CI, –20.6 to –0.4 deaths per million]).

More Doctors Needed

“Greater supply of primary care physicians appeared to increase the chances that a person would be treated for cardiovascular disease risk factors like high blood pressure or high cholesterol, or caught early for major cancers like breast cancer or colon cancer,” lead study author Sanjay Basu, MD, PhD, of Stanford University, told Reuters by email.

But while the study identified a correlation between life expectancy and PCP presence, it also found that the number of doctors is declining.

“While primary care physician availability relates to important goals like longer life and lower death rates, the number of primary care doctors is dwindling,” Basu said. “We need to do more to attract great medical students into the primary care field.”

Authors of an accompanying editorial said that a career as a PCP may not be inviting enough to attract more candidates.

“Despite successful training programs, there has been a steady decline in interest in primary care among US medical students. Those who choose primary care physician disciplines are not being attracted to practice in underserved rural or urban areas in large enough numbers,” the authors wrote. “This decline has been attributed to factors such as the desired income, level of debt, type of patients cared for, and perceived work hours and workload of a primary care physician.”

The authors of the present study concluded that “future analyses should explore the dynamics of teamwork across primary care physicians and specialists in both traditional and alternative payment models to address how team-based approaches may affect mortality and other outcomes.”

Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants: A Cohort Study

Primary Care Screening for Diabetic Retinopathy May Be Beneficial

Some Primary Care Providers Help with Cancer Treatment Decisions

Could Site of Care Affect Palliative Care in Minority Cancer Patients?

Source: JAMA Internal Medicine