Forty-Four Percent of Primary Care Providers from 2016 to 2022 Were Not Physicians, according to New FAIR Health Study
Nationally, from 2016 to 2022, 29 percent of patients receiving medical care did not visit a primary care provider, according to a new white paper from FAIR Health. This ranged from a high of 43 percent in Tennessee to a low of 16 percent in Massachusetts. These and other findings are detailed in the new report entitled A Window into Primary Care: An Analysis of Private Healthcare Claims.
Drawing on the nation's largest private healthcare claims database, US census data and National Plan and Provider Enumeration System (NPPES) data, this report provides an in-depth analysis of primary care with a focus on geography, physician versus nonphysician care and primary care specialties. In addition, the study reports on allowed amounts, telehealth utilization, diagnoses and behavioral health. Among the other key findings:
- Of the providers who performed primary care services in 2016-2022, 56 percent were physicians, while 44 percent were nonphysicians.
- The core-based statistical area (CBSA) with the lowest number of people per primary care provider in 2022 was Rochester, MN, with a ratio of 114.5, when measured by the provider's primary practice location.1 The CBSA with the highest number of people per primary care provider was Zapata, TX, with a ratio of 2,759.6, again when measured by the provider's primary practice location. The ratio of population to primary care provider, however, differed if calculated based on the location where patients received care.2
- Nurse practitioners constituted the largest share of primary care providers by specialty (27 percent), followed by family medicine physicians (20 percent), internal medicine physicians (18 percent) and physician assistants (15 percent). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others.
- The five states with the highest percentage of primary care patients receiving care from a nurse practitioner in 2016-2022 were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice.
- The five states with the highest percentage of primary care patients receiving care from a family medicine physician in 2016-2022 were more likely to be rural.
- From 2016 to 2022, average allowed amounts for CPT®3 99395 (established patient periodic preventive medicine examination for patients 18 to 39 years old) increased more for physicians than for nonphysicians.
- Telehealth use sharply increased at the start of the COVID-19 pandemic in all primary care specialties studied. Telehealth use then declined by over 30 percent in all primary care specialties studied from 2020 to 2021.
- In the period 2016-2022, nonphysicians treated greater percentages of patients with diagnoses related to mental health or acute respiratory diseases and infections than physicians did.
- From 2016 to 2022, the percentage of patients with a primary mental health diagnosis treated by a primary care provider increased 7.0 percent, while the percentage of patients with a primary substance use diagnosis decreased 2.5 percent. Primary care nonphysicians saw increases in patients with both behavioral health diagnoses of over 100 percent during the same period.
FAIR Health President Robin Gelburd stated: "Primary care is vital to the nation's healthcare system. We hope this study of primary care provides actionable findings for all healthcare stakeholders, including patients, providers, payors, policy makers and researchers."
For the complete study, click here.
FAIR Health is a national, independent nonprofit organization that qualifies as a public charity under section 501(c)(3) of the federal tax code. It is dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health possesses the nation's largest collection of private healthcare claims data, which includes over 40 billion claim records and is growing at a rate of over 2 billion claim records a year. FAIR Health licenses its privately billed data and data products—including benchmark modules, data visualizations, custom analytics and market indices—to commercial insurers and self-insurers, employers, providers, hospitals and healthcare systems, government agencies, researchers and others. Certified by the Centers for Medicare & Medicaid Services (CMS) as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health includes among the private claims data in its database, data on Medicare Advantage enrollees. FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users. FAIR Health's systems for processing and storing protected health information have earned HITRUST CSF certification and achieved AICPA SOC 2 Type 2 compliance by meeting the rigorous data security requirements of these standards. As a testament to the reliability and objectivity of FAIR Health data, the data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish, which enables consumers to estimate and plan for their healthcare expenditures and offers a rich educational platform on health insurance. An English/Spanish mobile app offers the same educational platform in a concise format and links to the cost estimation tools. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Dr. Marty Makary's book The Price We Pay: What Broke American Health Care—and How to Fix It and Dr. Elisabeth Rosenthal's book An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit fairhealth.org.