Estimated Effect on Life Expectancy of Alleviating Primary Care Shortages in the United States

Sanjay BasuRussell S PhillipsSeth A BerkowitzBruce E LandonAsaf BittonRobert L Phillips


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.

This article was featured in the April 21, 2022, Lunch and Learn discussion

This study investigated how primary care physician supply correlates with outcomes in the health care system. There have been multiple local, state and federal initiatives that seek to address these primary care physician shortages by recruiting and training more primary care physicians in underserved areas. These initiatives include the National Health Service corpsTeaching Health Center Graduate Medical Education (THCGME), and creation of new medical schools with a focus on training more primary care doctors (NYU Long IslandFlorida State).

  • If we alleviate primary care physician shortages in HPSA counties to have one primary care physician in 3500 people, life expectancy would increase by about 22.5 days. Counties where we alleviate shortages up to one in 1500, would increase life expectancy by about 56 days.
  • If we go up to the 1:1500 threshold, the study estimates 7000 averted deaths per year. Alleviating shortages to reach the 1:3500 ratio would require another 17,000 additional physicians or about 14.5 per county. If we go to 1:1500 threshold, that will require almost 100,000 more primary care physicians, which would be a major lift.
  • HRSA should consider going back to its 2010 rulemaking and consider updating its official definition of primary care physician shortages to be set at 1:1500.

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