Virginia Faces Primary Care Shortage Impacting 3.8 Million Residents

A recent study has revealed a significant shortage of primary care physicians in Virginia, affecting nearly 3.8 million residents across almost half of the state’s neighborhoods. Researchers from Virginia Commonwealth University analyzed anonymized health care claims data and found that 44% of census tracts in Virginia lack adequate access to primary care services. Rural communities are particularly impacted, facing the most severe workforce shortages. These findings were published in the Annals of Family Medicine, highlighting an urgent need for targeted interventions.

The lead author of the study, Hannah Shadowen, a Ph.D. and M.D.-Ph.D. student at VCU’s School of Medicine and School of Public Health, emphasized the critical role primary care physicians play in health care systems. “Primary care physicians are the foundation of any health care system,” Shadowen stated. “They help treat acute medical problems and manage chronic health issues like diabetes and hypertension.”

With the overall health care workforce shortages worsening in the United States, the demand for primary care providers is projected to escalate. According to estimates from the Association of American Medical Colleges, the nation may face a shortfall of over 55,000 primary care physicians by 2032, exacerbating the challenges for residents in underserved areas.

In communities with limited health care options, residents often travel longer distances for medical appointments, resulting in lower utilization of primary care services. This situation raises significant public health concerns, as insufficient access to primary care can lead to increased hospitalizations, emergency department visits, shorter lifespans, and greater health inequities.

To address these issues effectively, co-author Alex Krist, a professor in the VCU School of Medicine’s Department of Family Medicine and Population Health, pointed out the importance of understanding which communities face the most significant barriers to access. “In order to develop interventions that effectively address primary care shortages, we need to better understand which communities are facing the biggest barriers to access,” Krist noted.

The research team evaluated patient claims data from 2019 through the Virginia All-Payer Claims Database. They determined the number of physicians providing primary care in Virginia, their practice locations, and the patient load each physician managed. This analysis included obstetrician-gynecologists, internal medicine physicians, and pediatricians who provided wellness visits.

Shadowen remarked on the value of this data, stating, “Rather than giving a prediction on health care shortages, this data provides a realistic depiction of the primary care workforce in Virginia and where the shortages are felt most prominently.”

The team calculated the total patient capacity of all primary care physicians within a 30-minute drive of each census tract and compared this with the population size of those tracts. They also examined various demographic factors, including age, insurance coverage, income level, medical needs, disability rates, education level, rurality, and racial and economic segregation.

The findings revealed that there were 4,850 primary care physicians in Virginia in 2019, each seeing an average of 1,368 patients. Approximately 44% of Virginia’s census tracts did not have adequate access to primary care physicians. The analysis indicated that structural and geographic factors were the strongest predictors of primary care access. Rural areas experienced significantly less access compared to suburban or urban neighborhoods, with rural tracts averaging approximately 725 fewer patients per physician than suburban regions.

Shadowen pointed out that this disparity may be linked to the location of primary care residencies, which predominantly exist in urban or suburban settings. Research has shown that physicians often practice in areas where they completed their residency training. “These findings show that more work needs to be done to increase Virginia’s rural primary care workforce,” she stated. Suggestions for improvement include expanding residency programs in rural settings and establishing incentive programs, such as loan repayment benefits, to encourage practitioners to work in underserved areas.

Interestingly, the study also uncovered that census tracts with higher proportions of Black residents had better access to primary care services compared to predominantly white neighborhoods. Shadowen suggested that this trend might be attributed to the fact that many predominantly Black neighborhoods are situated in urban areas, which typically have a higher concentration of primary care physicians. Local and national efforts, such as Federally Qualified Health Centers and pathway programs, may also contribute to improved access in these communities.

While access to primary care is crucial, the researchers noted that it does not automatically guarantee utilization of these services. Their future studies will focus on understanding how access influences the likelihood of residents seeing a primary care physician in Virginia, aiming to further address the pressing issue of health care accessibility across the state.