While she and her colleagues on the study – including surgery assistant professor Andrew Ibrahim, M.D., M.Sc. – did not find a difference in patients’ risk of death based on severity of primary care shortage, they did show that mortality risk was lower for those living in non-shortage areas compared with shortage areas.
Primary care supply
The results of the study, the authors say, should underscore the importance of efforts to increase the supply of primary care providers and to attract them to practice in underserved areas.
This includes both rural and urban primary care shortage areas; the study found that 58% of the census tracts classified as having a primary care shortage of any level were rural.
Loan forgiveness and restructuring programs, to alleviate the education related debt of physicians and other providers, are a key tool in this effort, Schaefer notes. Encouraging more providers to choose primary care careers, rather than specializing, and incentivizing them to practice in areas of shortage, could ultimately mean better outcomes when people living in those areas need time sensitive operations, even if they travel many miles to get to the operating room.
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The study does not include data on people covered by Medicaid, VA or private insurance, but Schaefer hopes other researchers will attempt to duplicate the findings in those populations.
In the meantime, she says, the message to people living in shortage areas is to seek out a primary care provider to have as a regular source of care, even if getting an appointment takes a while because of shortages. And, she says, don’t ignore new symptoms; instead, know how to escalate a concern with your regular provider.
For surgeons, she said, the realization that some of their patients having urgent or emergency surgery might be doing so because they don’t have access to a regular primary care provider is an important one.
“Use the post-surgery hospitalization as a time to intervene and facilitate contact with a primary care provider who can assist with recovery and with other health issues the patient may be facing,” she said. “The role of the primary care doctor as a partner in care of our surgical patients cannot be overstated.”
Additional authors: In addition to Schaefer and Ibrahim, who is a member of the U-M Institute for Healthcare Policy and Innovation, the authors of the study are CHOP fellow and Surgery resident Shukri H. A. Dualeh, M.D., CHOP statistician Nicholas Kunnath, M.S., and John W. Scott, M.D., M.P.H., formerly of U-M and now at the University of Washington.
Funding: The study was funded by the National Institutes of Health (CA236621) and the Agency for Healthcare Research and Quality.
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