Measuring Primary Care Capacity: Unique Patients Seen per Year and Implications for Workforce Shortages

There is a growing primary care workforce shortage. Primary care physicians (PCPs) already have a broad scope of work yet face increasing demands on their time and pressure to see more patients. This analysis aims to update PCP workforce shortage estimates by assessing the number of unique patients seen per year by each PCP in Virginia.

From Virginia's all-payer claims database (APCD), we identified the unique number of patients seen annually between 2016 to 2021. We evaluated variation by physicians, practices, and communities by using licensure, claims, census, and Virginia Department of Health clinician survey data for PCPs across family medicine, internal medicine, pediatrics, and ob-gyn. We conducted iterative bootstrap simulation analyses to estimate the PCP workforce shortage, accounting for panel size and Full-Time Equivalent (FTE).

There are 4,508 PCPs in Virginia, with 34.2% of PCPs over age 60 compared with 24.0% aged 30 to 49. The median number of unique patients seen by physicians in 2021 was 1,290. On average, physicians had 2,800 total visits annually, and patients were seen 2.12 times per year. PCPs saw more patients if they were aged 40 to 59, worked in health systems, practiced in rural communities, or served communities with lower social needs. Average FTE was 0.847 (SD: 0.215). In 2021, 1,305 additional PCPs were needed for each Virginian to have a PCP, preventing a 28.8% shortfall (95% CI: 27.9%-30.0%). This marks an increase from a 17.7% shortfall in 2016.

Primary workforce shortages are more dire than prior estimates when accounting for number of patients seen per year and FTE. The ideal number of patients a PCP can care for should be determined by clinicians and practices, with consideration of patient complexity, physician capacity, and practice resources.