Relationship Between Primary Care Physician Capacity and Usual Source of Care.

Background: The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC.

Racial Inequities in Female Family Physicians Providing Women's Health Procedures.

Patient-physician race concordant dyads have been shown to improve patient outcomes; the race and ethnicity of family physicians providing women's health procedures has not been described. Using self-reported data, this analysis highlights the racial disparities in scope of practice; underrepresented in medicine (URiM) females are less likely to perform women's health procedures which may lead to disparities in care received by minority women.

Female Family Physicians Are More Racially Diverse Than Their Male Counterparts in Federal Sites.

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts.

Proportion of Family Physicians in Solo and Small Practices is on the Decline.

Although solo and small practices are a vital part of primary care, the proportion of family physicians reporting working in practices with 5 or fewer providers declined from 15% to 11% for solo and 37% to 34% for small (2 to 5 providers) practices from 2014 to 2018. These decreasing trends are concerning, mainly when a low proportion of family physicians have solo practices in rural locations given the access to care challenges in these underserved populations.

Uniting Public Health and Primary Care for Healthy Communities in the COVID-19 Era and Beyond.

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds.

Not Telehealth: Which Primary Care Visits Need In-Person Care?

The Coronavirus disease 2019 (COVID 19) pandemic has resulted in a rapid shift to telehealth and many services that need in-person care have been avoided. Yet, as practices and payment policies return to a new normal, there will be many questions about what proportion of visits should be done in-person vs telehealth. Using the 2016 National Ambulatory Medical Survey (NAMCS), we estimated what proportion of visits were amenable to telehealth before COVID-19 as a guide.

Capacity of Primary Care to Deliver Telehealth in the United States.

Background: Because of the Coronavirus disease 2019 (COVID 19) pandemic, many primary care practices have transitioned to telehealth visits to keep patients at home and decrease the transmission of the disease. Yet, little is known about the nationwide capacity for delivering primary care services via telehealth.

Methods: Using the 2016 National Ambulatory Medical Survey we estimated the number and proportion of reported visits and services that could be provided via telehealth.

Site of Care for COVID-19-Like Respiratory Illnesses.

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider.

A Cross-Sectional Study of Factors Associated With Pediatric Scope of Care in Family Medicine.

Purpose: The objective of this study was to identify demographic and practice characteristics associated with family physicians' provision of care to children including a subgroup analysis of those who see pediatric patients younger or older than 5 years of age.

Methods: This cross-sectional study used data from US family physicians taking the American Board of Family Medicine continuous certification examination registration questionnaire in 2017 and 2018. The outcome of interest was self-reported care of pediatric patients in practice.

Gender Differences in Reported Weekly Work Hours Among Family Physicians.

While women are entering family medicine at higher rates than men, little is known about the present differences in practice patterns between male and female family physicians (FPs). We used 2017 and 2018 American Board of Family Medicine Family Medicine Certification Examination practice demographic questionnaires to assess average weekly total hours and direct patient care hours by age and gender reported by FPs. We found a gender gap between both overall hours worked and direct patient care hours, with female FPs reporting fewer hours across age groups.

The Evolving Family Medicine Team.

A decade of practice transformation, consolidation, and payment experimentation have highlighted the need for team-based primary care, but little is known about how team composition is changing over time. Surveys of Family Physicians (FPs) from 2014-18 reveal they continue to work alongside inter-professional team members and suggest slow but steady growth in the proportion of FPs working with nurses, behaviorists, clinical pharmacists, and social workers.

The Declining Presence of Family Physicians in Hospital-Based Care.

Despite training to provide care across the continuum of health delivery settings, the proportion of family physicians (FPs) reporting inpatient care has decreased by 26% between 2013 and 2017, leaving approximately 1 in 4 of FPs practicing hospital medicine in 2017. Policy makers, payers, and leaders in medical education should closely track the impact of these trends, given previous evidence associating better cost and utilization outcomes with broader scope of practice.

Practice Intentions of Family Physicians Trained in Teaching Health Centers: The Value of Community-Based Training.

Family medicine residents who graduate from Federally Qualified Health Center-aligned Teaching Health Center (THC) training residencies are nearly twice as likely to pursue employment in safety-net settings compared with non-THC graduates. This trend has been consistent over the past few years, suggesting that the program is fulfilling its mission to strengthen primary care in underserved settings.

30% of Recent Family Medicine Graduates Report Participation in Loan Repayment Programs.

Rising educational debt may discourage entry into primary care and practice in safety net settings, but little is known about participation in loan repayment programs that are thought to be part of the solution. A survey of 2052 recent family physician residency graduates found that 30% pursued loan repayment, only a portion of which is tied to service obligations, suggesting opportunities for research and areas for the attention of policymakers.

Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality.

Purpose: Little is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation).

Methods: Across 12 practices, we assessed the relationship between cold spots and clinical outcomes (obesity, uncontrolled diabetes, pneumonia vaccination, cancer screening-colon, cervical, and prostate-and aspirin chemoprophylaxis) for 152,962 patients.

Advancing Primary Care Through Alternative Payment Models: Lessons from the United States & Canada.

The United States and Canada share high costs, poor health system performance, and challenges to the transformation of primary care, in part due to the limitations of their fee-for-service payment models. Rapidly advancing alternative payment models (APMs) in both countries promise better support for the essential tasks of primary care. These include interdisciplinary teams, care coordination, self-management support, and ongoing communication.

Increased Public Accountability for Hospital Nonprofit Status: Potential Impacts on Residency Positions.

Background: The Institute of Medicine recently called for greater graduate medical education (GME) accountability for meeting the workforce needs of the nation. The Affordable Care Act expanded community health needs assessment (CHNA) requirements for nonprofit and tax-exempt hospitals to include community assessment, intervention, and evaluation every 3 years but did not specify details about workforce. Texas receives relatively little federal GME funding but has used Medicaid waivers to support GME expansion.

Intention Versus Reality: Family Medicine Residency Graduates' Intention to Practice Obstetrics.

Although 21% of new family medicine graduates in 2016 reported an intention to include obstetric delivery in their scope of practice, only 7% of family physicians currently do so. The reasons for this stark difference must be identified in order to address potential barriers leading to family medicine graduates ultimately not including obstetric delivery despite intent.

Analysis of 2011 physician assistant education debt load.

This study seeks to investigate how physician assistants (PAs) finance their education and to characterize the educational debt of PA students. Data from the 2011 American Academy of PAs (AAPA)-Physician Assistant Education Association Graduating Student Survey were used to explore the educational debt of PA students. The median total educational debt of a PA student graduating in 2011 was $80,000.

New "Core Quality Measures": Only a Beginning.

A plethora of quality measures are used in health care for quality improvement, accountability (including reimbursement), and research. The Core Quality Measures Collaborative, with input from the American Association of Family Physicians, recently released several groups of reduced core measure sets, including one for primary care. The proposed measures are less helpful for the increasing proportion patients with multiple morbidities or advancing illness.

A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable.

Primary care panel sizes are an important component of primary care practices. Determining the appropriate panel size has implications for patient access, physician workload, and care comprehensiveness and will have an impact on quality of care. An often quoted standard panel size is 2500.

Over Half of Graduating Family Medicine Residents Report More Than $150,000 in Educational Debt.

Primary care workforce shortages are thought to result not only from lower remuneration than other specialties but also from increasing amounts of debt at graduation. A census of 3083 graduating family medicine residents found that 58% reported having >$150,000 in educational debt and 26% reported having >$250,000-levels that may deter students' interest in primary care and constrain the practice location choices of those who do choose primary care.

The Diversity of Providers on the Family Medicine Team.

Family physicians are increasingly incorporating other health care providers into their practice teams to better meet the needs of increasingly complex and comorbid patients. While a majority of family physicians report working with a nurse practitioner, only 21% work with a behavioral health specialist. A better understanding of optimal team composition and function in primary care is essential to realizing the promise of a patient-centered medical home and achieving the triple aim.

Direct Primary Care: Practice Distribution and Cost Across the Nation.

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the "concierge" practice; and describe the model's pricing using data compiled from existing DPC practices across the United States. Lower price points and a broad distribution of DPC practices were confirmed, but data about quality are lacking.