Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia.

Area of Science:

• Health Services Research
• Public Health Policy
• Physician Workforce Analysis

Background:

• Primary care is crucial for extending lifespan and improving health equity.
• Previous physician workforce studies often relied on limited data, potentially overestimating physician numbers.
• Accurate data on primary care physician distribution is essential for effective healthcare planning.

Purpose of the Study:

• To develop and validate a pragmatic, systematic method for accurately identifying primary care physicians.
• To determine the realistic size and composition of the primary care physician workforce in Virginia.
• To provide a reliable method for policymakers and planners to assess primary care capacity.

Main Methods:

• Utilized the National Plan and Provider Enumeration System (NPPES) and Virginia All-Payer Claims Database (VA-APCD) for physician identification and activity status (2015-2019).
• Defined active physicians by at least one claim in the VA-APCD.
• Employed a hierarchical specialty determination via NPPES and identified primary care providers through wellness visit data for non-family medicine specialists.

Main Results:

• In 2019, Virginia had 20,976 active physicians, with 5,899 (28.1%) classified as primary care providers.
• The primary care physician workforce comprised 52.4% family medicine, 18.5% internal medicine, 16.8% pediatricians, and 11.8% obstetricians/gynecologists.
• Physician counts and relative percentages in primary care remained stable over the study period.

Conclusions:

• The novel NPPES and VA-APCD-based method provides a more realistic estimate of the active primary care physician workforce in Virginia.
• This approach offers a valuable tool for policymakers, payers, and planners to ensure adequate primary care capacity.
• Future work should incorporate advanced practice clinicians and further refine the scope of practice delineation.