A doctor holding a patient's hand for an examination
Primary care is the foundation of a functional health care system. Using health care claims data, a research team led by VCU School of Medicine has found that Virginia’s primary care workforce is up to 25% smaller than previous estimates. (Getty Images)

Virginia’s primary care workforce is up to 25% smaller than previous estimates, new VCU-led study suggests

Having a comprehensive understanding of the state’s primary care capacity is essential for establishing equitable access to primary care.

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In a new study led by Virginia Commonwealth University’s School of Medicine, researchers developed a novel method for determining the number of primary care physicians in Virginia. Their results revealed that the state’s primary care workforce may be spread thinner than previously believed.

Using health care claims data, the research team identified 5,899 active physicians who provided primary care services, such as wellness examinations, in Virginia between 2015 and 2019, a number that’s up to 25% smaller than some previous estimates. The findings, published this week in the Annals of Family Medicine, provide a more realistic assessment of primary care accessibility in the state.

“Primary care is the foundation of a functional health care system. That’s how we give patients access to care, collaborate with other clinicians to coordinate care and provide continuity for each patient. Primary care physicians are essential for promoting health, preventing disease and improving health equity,” said Alison Huffstetler, M.D., an assistant professor and clinician researcher at the School of Medicine’s Department of Family Medicine & Population Health, who is the lead author of the new study. “Having a comprehensive understanding of the primary care workforce is essential for establishing equitable access to primary care, planning for future workforce needs and adapting policies that address primary care reimbursement.”

While some resources already exist for calculating the number of primary care physicians in different states, the data used for these estimates have limitations that overestimate the workforce. 

“Many of these resources utilize survey results that are self-reported by physicians and aren’t regularly updated. This kind of method makes it hard to keep track of when a physician graduates from residency, moves to a different state or retires,” Huffstetler said. 

Additionally, this data doesn’t capture instances when primary care services are provided by specialists. For example, some physicians in rural regions broaden the scope of their practice to accommodate primary care needs within their communities.

“We wanted a complete picture of who is providing primary care in Virginia. To do so, it was important that we accounted for both the traditional primary care workforce and specialists who are acting in a primary care functioning capacity,” Huffstetler said. 

Huffstetler and her colleagues developed a more accurate method for identifying active primary care physicians through the use of patient claims data. Because patient claims document the specific services provided by a physician during a patient visit, the researchers were able to measure occurrences of primary care practice. 

The research team first assessed data from the National Plan and Provider Enumeration System to identify all physicians based in Virginia. They then evaluated de-identified patient claims data from 2015-2019 through the Virginia All-Payer Claims Database. The researchers used this database to determine which physicians were actively providing primary care services during this time period. 

The researchers identified 20,976 active physicians in Virginia, 5,899 of whom were providing primary care services. This number was similar to data from the American Medical Association but 25% smaller than the Association of American Medical Colleges’ estimates

The results of this study bring experts closer to understanding Virginia’s primary care capacity. This could help Virginia legislators and planners implement policy changes to ensure equitable primary care access across all communities.

Furthermore, many factors over the past few years have had an impact on Virginia’s primary care capacity, including the expansion of Medicaid and the COVID-19 pandemic. There also is a large cohort of primary care physicians who are approaching retirement. As the availability and demand of primary care services changes, having an accurate estimate of the primary care workforce will help pinpoint where more physicians are needed.

The researchers were intentional about utilizing data systems that are both accessible and relevant to regions outside of Virginia. The method developed in this study could help other states better understand the breadth of their own primary care services. 

Looking forward, the research team plans to further evaluate the primary care services that physicians are providing in Virginia, as well as examine telehealth access across the state.

“I became a family doctor because I wanted to make sure that my community had access to thoughtful, well-resourced care,” Huffstetler said. “That's what drives my care every day, and I hope that every family can find equitable, high-quality primary care in their own neighborhoods.”