The Affordable Care Act’s expansion of insurance coverage is expected to increase demand for primary care services. We estimate that the national increase in demand for such services will require 7,200 additional primary care providers, or 2.5 percent of the current supply. On average, that increased demand is unlikely to prove disruptive. But when we examined how this increased demand will be experienced in different areas of the country, we found considerable variability: Seven million people live in areas where the expected increase in demand for providers is greater than 10 percent of baseline supply, and forty-four million people live in areas with an expected increase in demand above 5 percent of baseline supply. These findings highlight the need to promote policies that encourage more primary care providers and community health centers to practice in areas with the greatest expected need for services.
The adequacy of the primary care workforce to meet the current and future needs of the American public has been a public health concern for decades.1,2 The size and distribution of that workforce is strongly associated with the ability to provide adequate primary and secondary preventive services for a population.3
That concern has been heightened by the passage of the Affordable Care Act, which is expected to greatly increase the number of insured individuals, starting in 2014. That increase, in turn, will boost demand for primary care services, potentially straining the primary care workforce4,5 and even limiting access to health care for both the newly and the currently insured. A recent study by Adam Hofer and colleagues estimated that the country will need between 4,307 and 6,940 additional primary care physicians to meet new demands created by insurance coverage expansion.6
If there were no change in the organization or delivery of health care, Hofer’s results suggest that we would need an increase of approximately 2.0–3.0 percent in the supply of primary care providers to satisfy the increased demand from the newly insured.7 Working on the assumption that nurse practitioners and physician assistants will meet part of that increase in demand, we anticipate that there will be a 1.5–2.4 percent increase in demand for primary care physicians.
To be sure, the impact of the increased demand for primary care providers may be attenuated by changes in how primary care is delivered. Shorter primary care visits could allow a provider to see additional patients in a day. Another possibility is that practitioners will alter their recommendations concerning the length of time before a patient returns for a subsequent visit.
However, as Hofer’s analysis shows, the estimated increase in demand varies across the United States, with the potential strain on the primary care workforce greater in some states than in others. The variation is based on two state characteristics: the number of uninsured and the existing primary care capacity.
The greater demand is likely to be manageable in most states with relatively small adjustments in the delivery system. The largest increases are estimated to occur in Texas (which has an estimated 5.3 percent increase in demand), Mississippi (4.8 percent), Nevada (4.5 percent), Idaho (4.4 percent), and Oklahoma (4.1 percent).6 Similarly, Leighton Ku and colleagues have observed that Georgia, Kentucky, Louisiana, Nevada, North Carolina, Oklahoma, and Texas have weak primary care capacity but are still expected to have large Medicaid expansions.8
We hypothesize that the increases in demand will not be uniform across each state. Instead, it is more likely that increases will be greater than average in areas of a state with higher numbers of currently uninsured people or fewer primary care providers.
The goal of this study was to identify small areas expected to face large increases in demand for primary care services because of insurance coverage expansion, and to estimate the number of people living in such areas. Doing so will contribute to formulating policy responses, potentially including the targeting of National Health Service Corps Scholarship and Loan Repayment Program funds to those areas, or providing additional incentives through vehicles such as the Medicare Physician Bonus Payment Program.