Can Better Workflows Take the Edge Off the Primary Care Physician Shortage?

According to the Association of American Medical Colleges, the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care.

The escalating crisis is underscored by the pressure on primary care physicians (PCPs) to not only manage a range of chronic diseases but also address cognitive concerns of an aging general population (Alzheimer’s Association). As the population growth outpaces the supply of PCPs, and as more physicians approach retirement age, the gap widens.

Administrative tasks associated with running a practice often may pose an unexpected burden for numerous types of physicians. All these factors, combined with the financial struggles inherent in healthcare and limited financial support from the federal government, have added to the strain on PCPs. 

In this article, we unpack the reasons behind the physician shortage, and discuss actionable strategies for clinicians to mitigate its impact on public health and approach sustainable healthcare.

Understanding What’s Causing the Primary Care Dilemma

The shortage of primary care physicians has been fueled by several factors (Malayala et al., 2021): 

1. Fewer medical graduates choosing primary care
2. A significant retirement wave of physicians
3. Administrative burden overwhelming the healthcare system
4. Financial and funding challenges
5. An aging population
6. Rural healthcare challenges
7. Physician burnout

Below we’ll expand on each of these.

Fewer Medical Graduates Choosing Primary Care

Across North America, there has been a steady decline in the percentage of medical students ranking family medicine as their top residency choice—from 38% in 2015 to 30.7% in 2022 (CBC). One of the suggested reasons is that the allure of specialization may divert many medical school graduates from family practice. Specialized fields often offer higher compensation, which can be a significant draw away from primary care disciplines.

The Great Retirement Wave: Navigating the Departure of the Physician Workforce

According to the American Medical Association, more than two of every five active physicians will be 65 or older in the next decade. This demographic shift decreases the number of active PCPs who represent an accumulation of years of experience.

Administrative Burden Overwhelming the Healthcare System

Research indicates that the administrative burden on physicians is one of the leading factors leading to a decrease in the number of people within the workforce. A study published in the Annals of Internal Medicine found that for every hour a physician spends in direct patient care, nearly two additional hours are consumed by paperwork. The cumulative effect of these demands can contribute to burnout, potentially causing physicians to leave the field or reduce their patient load, thereby exacerbating the shortage.

Read more: Strategies to Alleviate the Administrative Burden in Healthcare 

Additionally, the pressure to keep up with rapidly advancing medical technology and evolving regulations and payment models requires continuous learning and adaptation. While essential to success in the role, it can cause undue stress for physicians without access to the resources or time dedicated to this continued education. Lack of educational resources and training has been cited as one cause for a shortage of nurses in the U.S, for example (Tamata et al., 2022).

Financial and Funding Challenges

According to the University of Pennsylvania's Leonard Davis Institute of Health Economics, primary care accounts for only around 5% of total US healthcare spending, while specialty practices receive 17%. Healthcare costs, funding difficulties, and reimbursement complexities contribute to the issue. The financial model of primary care often does not favor the time-intensive, whole-person approach that PCPs often take, which may contribute to economic disincentives for physicians to enter or remain in primary care.

An Aging Population

The heightened demand for more specialized care for the aging population adds to the workload of PCPs. The US population aged 65 and older is expected to increase by 34.1% from 2021 to 2036, and the 75+ age group by 54.7%, as reported by the AAMC. As people live longer, they often require more complex and chronic care management, which places additional demands on the already strained primary care system. In particular, cognitive health services are in greater demand, such as screening for MCI and dementia, as the patient population ages.

Rural Healthcare Challenges

Unique challenges in rural areas, such as geographic isolation, limited resources, and a smaller healthcare workforce, make attracting and retaining PCPs in these regions difficult (Malayala et al., 2021). For these areas to have better healthcare access, the US would need an additional 202,800 physicians, as reported by the AAMC. These factors contribute to significant healthcare disparities between rural and urban populations.

Physician Burnout

The immense pressure on the healthcare system, especially during the COVID-19 pandemic, has led to increased burnout rates among physicians. Various studies place burnout symptoms and rates anywhere between 42%–63% in physicians in the U.S. (De Hert, 2020, Alkhamees et al., 2021, Alkhamees et al., 2022). The chronic stress associated with long hours, high patient volumes, and the emotional toll of providing care can lead to burnout, which in turn exacerbates the shortage of PCPs as they leave the profession or reduce their hours.

The COVID-19 pandemic has further intensified these pressures, as healthcare providers have faced surges in patient volumes, shortages of personal protective equipment, and the emotional toll of treating seriously ill patients. This has accelerated burnout rates, as documented in a survey by the Physicians Foundation, where 58% of physicians reported feelings of burnout in 2020, compared to 40% in 2018.

Read more: Tackling Physician Burnout: Strategies for Well-Being and Resilience 

Challenges Resulting from the PCP Shortage

The primary care physician (PCP) shortage presents a multitude of challenges that ripple through the healthcare system, affecting both providers and patients. Among the most concerning is the erosion of patient trust and experience. 

Erosion of Patient Trust

Overburdened PCPs may have less quality time for each patient, potentially leading to a perceived lack of empathy or attention, undermining the patient-provider relationship. A 2023 study found that PCPs would require an infeasible 26.7 hours per day to account for preventative care for a panel of 2500 patients, concluding that the physician workforce doesn't have enough time for the level of quality primary care that physicians wish to deliver.

Healthcare Inequities

The shortage exacerbates healthcare inequities, especially in rural communities and among marginalized groups. The Department of Veterans Affairs found that less than 12% of physicians in the US practice in rural areas, despite around 20% of the population living in rural communities.

Increased Wait Times

Patients may face long waits for appointments, delaying diagnoses and treatments, which can worsen health outcomes. For example, in a study on wait times for specialized psychiatric care, patients waited a median 67 days and 43 days for in-person and telepsychiatry appointments (Sun et al., 2023).

Burnout and Turnover

The emotional and physical toll of the shortage on healthcare workers leads to burnout and higher turnover rates, which further worsen the shortage. A 2024 study found that the overall mean burnout score (according to the Copenhagen Burnout Inventory) among healthcare professionals was an average of 57.4%.

Workflow Strategies to Ease the Primary Care Physician Shortage

With the combination of an aging population and an exodus of physicians from healthcare—due to retirement and burnout-related turnover—PCPs need to adapt to the changing landscape of today’s healthcare.

Addressing this combination of factors can involve turning to solutions for more efficient health monitoring, especially those geared toward an aging population. With the prevalence of age-related cognitive conditions such as MCI and dementia, better cognitive care tools are in demand. These solutions should be cost-effective, easy to administer, and provide robust health data, so that PCPs are better prepared to meet the needs of this growing patient population.

Below, we look at solutions such as computerized cognitive assessments and mental health questionnaires as ways to address the challenges posed by the PCP shortage effectively.

Computerized Cognitive Assessments

In the context of the PCP shortage, using computerized cognitive assessments can ease the strain physicians experience when needing to respond to the needs of an aging population. At the same time, they can enhance patient care. These assessments measure and provide detailed reports on individuals’ performance across various domains of cognition.

How can computerized cognitive assessments ease physician shortages?

• Enable telemedicine

• Enable further accessibility and reach to patient populations
• Cost-effective
• Less time consuming
• Produce immediate reports
• Integrate with patient records
• Reduce administrative burden

Derived from traditional pen-and-paper tests and validated through use in over 300 research studies, Creyos cognitive tasks swiftly and accurately assess distinct brain functions. Clinicians receive real-time, quantifiable insights into a patient’s short-term memory, reasoning skills, attention, and verbal ability, enabling more precise clinical decisions, aiding diagnosis, and enhancing treatment planning.

Behavioral and Mental Health Questionnaires

Physicians increasingly need to address mental and behavioral challenges associated with the needs of an aging population. Mental disorders are an under-evaluated modifiable risk factor for dementia, according to research in (Richmond-Rakerd et al., 2022). 

Cognitive impairment is also associated with mental disorders such as depression and anxiety (Millan et al., 2012). By being better equipped to evaluate mental and behavioral health, PCPs can potentially better address their patients’ emerging cognitive challenges.

Behavioral health questionnaires are another tool that can help PCPs manage patient care more effectively. These questionnaires can screen patients for specific disorders such as:

• Depression
• Anxiety
• ADHD
• Mood disorders
• PTSD
• Substance abuse
• And more

Digital versions of standardized patient self-report health questionnaires, such as those available through Creyos, aid in diagnosis, treatment, and monitoring of the ongoing mental health of patients in a consistent and scalable way, saving providers time while helping them deliver superior care and treatment programs. Tools like the GAD-7 and PHQ-9 are widely recognized for screening anxiety and depression in primary care settings (Newman, 2022).

Consolidated Longitudinal Reporting

Consolidated longitudinal reporting refers to the comprehensive collection and analysis of patient health data over extended periods. As cognitive concerns are on the rise with an aging population, routine cognitive health checks become important both on the individual level and on a systemic level. For individuals, they allow physicians to detect early signs of decline. And on a systemic level, they enable the development of predictive diagnostic tools.

With routine cognitive tests that detect meaningful change across longitudinal reports, physicians can significantly enhance the continuity and quality of care they deliver. Maintaining detailed, long-term records of patient interactions, diagnoses, treatments, and outcomes, are all part of this approach (Broyles et al., 2016).

It is especially important to measure cognitive changes over time, and Creyos is a powerful tool for doing so. With the ability to easily re-administer tests for comparative analysis, Creyos provides clear charts depicting a patient's cognitive progression. This enables providers to have objective, data-driven discussions with patients about symptom progression, which is essential for making informed decisions regarding treatment plans. 

By integrating the strategies we’ve covered above, healthcare providers can maintain a high standard of patient cognitive care even in the face of workforce shortages.

Final Thoughts: Delivering Care Under Pressure

Resolving physician shortages requires systemic changes such as enhancing the appeal of primary care as a career choice through educational opportunities and nationwide awareness campaigns.

The US faces a severe shortage of primary care physicians, with projections indicating a need for tens of thousands more PCPs by the mid-2030s due to multiple factors including physician retirement.

While we navigate this crisis, it’s essential to remember that at the heart of it all are patients in need of care. Ensuring that they continue to receive the care they need will require innovative strategies, collaboration, and a commitment to sustainable healthcare.