A Window into Primary Care

April 27, 2023

Primary care is at the heart of the healthcare system. Yet almost one in three people didn’t visit a primary care provider (PCP) from 2016 to 2022. Also, just over half of the PCPs during that time were medical doctors. The rest were other healthcare providers, such as nurse practitioners and physician assistants. This is shown in a new report by FAIR Health, along with other findings on primary care.

Primary care is a basic form of healthcare. PCPs can treat a wide range of health problems. They can also link patients to specialists (doctors with special training in an area of healthcare) when needed.

People and PCPs
The report shows 29 percent of people who got healthcare in America didn’t see a PCP. This varied by state. Tennessee had 43 percent of people who didn’t see a PCP. On the low end, Massachusetts had 16 percent of people who didn’t see a PCP. The report also shows that some parts of the country had more people per PCP than others. Rochester, Minnesota, had the lowest number of people per PCP (115 people). Zapata, Texas, had the highest number of people per PCP (2,760 people). But there were also differences within states. Some states had areas with both high and low numbers of people per PCP, like Texas, Georgia and Michigan.

PCP Types
Of the PCPs studied, 56 percent were medical doctors, including internists, family doctors, pediatricians and OB/GYN doctors. The other 44 percent were nurse practitioners, physician assistants and others. The study shows the largest share of PCPs were nurse practitioners (27 percent) once you separate out the physicians into various categories. The next largest were family doctors (20 percent). Then came internists (18 percent) and physician assistants (15 percent). The other PCPs were children’s doctors (pediatricians), OB/GYN doctors and others.

The PCP types varied in different states. In some states, laws allow nurse practitioners to treat patients and give medicine like a medical doctor. In other states, they aren’t allowed to do as much. Or they must check with a doctor before they give treatments. Nurse practitioners gave more primary care in states where they were allowed to do more, like Maryland, Arizona and Kansas.

Telehealth is when people get in touch with their healthcare provider on a device, such as a phone or computer. The report shows that people used telehealth a lot at the start of the COVID-19 pandemic. Compared to 2019, telehealth use went up by over 1,000 percent in 2020 for all PCPs. This was likely due to the pandemic shutdown. Many people used telehealth to lower the risk of getting COVID-19.

Physician assistants and nurse practitioners had the highest rises in telehealth. This is probably because during the shutdown, laws changed, and they were allowed to treat patients using telehealth in different states. The study also showed that telehealth use went down by over 30 percent from 2020 to 2021 for all PCPs. This was after the shutdown when some people went back to visiting their PCP in person. From 2021 to 2022, telehealth went down again, but only by four to nine percent for most PCPs. However, telehealth for children’s doctors went down by over 30 percent for a second time.

Mental Health and Substance Use
The share of people treated by a PCP for mental health issues grew by seven percent. The share of people treated by a PCP for a substance use disorder decreased by 2.5 percent. PCPs who weren’t doctors saw more people for mental health and substance use issues in 2022 than in 2016. The share of people they saw grew by over 100 percent.