- The full-time equivalent (FTE) primary care physician (PCP) workforce in Delaware is down 6 percent since 2013, according to a recent study commissioned by the Delaware Department of Health and Social Services (DHSS).
The report, which was completed by the University of Delaware Center for Applied Demography & Survey Research, specifically found that there were 815 PCPs practicing in the state in 2018. That is down from 862 in 2013, the researchers reported.
Those numbers shrunk when looking at FTE PCPs. In 2013, Delaware was home to 707 FTE PCPs and 662 in 2018.
“The best preventive care and the most cost-effective care is provided by a strong and coordinated primary care workforce,” DHSS Secretary Kara Odom Walker, MD, a board-certified family physician, said in a statement.
“Primary care providers know their patients and their medical histories best and can provide the most effective, high-value, longitudinal care for chronic health conditions and other preventable disease,” she added. “As state government officials, our priority is to find ways to incentivize front-line care to perform as coordinated teams that are ultimately accountable for population health. We also need more primary care physicians to remain in practice and find ways to encourage new doctors, including those from minority and rural backgrounds, to choose primary care as their specialty.”
This decrease in the PCP workforce has resulted in patient care access issues for new patients. Eighty-two percent of PCPs accepted new patients in 2018, compared to 86 percent who did so in 2013.
That proportion was more striking for Medicaid beneficiaries. Seventy-eight percent of PCPs said they accepted new Medicaid patients in 2013, while only 72 percent said the same in 2018. This disparity could be of issue for this high-risk population, especially since Delaware opted into Medicaid expansion in 2014.
The researchers also found that nearly 30 percent of PCPs plan to retire or exit the workforce within the next five years. Further probing revealed regional disparities in this trend.
For example, in Kent County, 25 percent of PCPs are over age 65 and 21 percent of all PCPs said they were certain they would exit the profession in the next five years.
In contrast, 16 percent of primary care physicians in Sussex County are over age 65 and just under 17 percent said they plan to retire. Thirteen percent of PCPs in New Castle County are over age 65 and 14 percent plan to retire in the next five years.
Despite these findings, the researchers said the state of the provider workforce in Delaware is still positive.
Patients are still able to avoid long wait times, and in many cases have even seen decreased wait times in the past five years, the report authors said. In 2018, the average new patient saw a 23-day wait time, compared to 32 days in 2013. An established patient faced six-day wait times, compared to 17 days in 2013.
There should still be enough primary care physicians to meet patient demand in coming years, the authors confirmed, although “their location and specialty is probably not optimal,” they wrote.
In fact, the patient-to-PCP ratio in Delaware is still exceeds standard expectations set by the US Health Resources and Services Administration (HRSA). Ideally, a state would have a 2,000 pateints to one PCP ratio. In even the most disparate Delaware county, Kent County, the patient-to-PCP ratio is 2,069 to one.
Nonetheless, the state is working to preemptively improve the primary care physician workforce.
A bill passed during the 2017 to 2018 Delaware Senate calendar established the Primary Care Collaborative. The Collaborative sets to establish policy changes that could strengthen the PCP workforce. While the Collaborative is expected to release long-term recommendations in response to the report, its leaders did assert that changes are needed to better support the primary care specialty.
“It is vital that the State of Delaware, for the sake of Delawareans' health, take steps to promote and strengthen primary care,” said Sen. Bryan Townsend, who sponsored Senate Bill 227 with Rep. David Bentz.
“The declining rates of primary care providers practicing in Delaware or offering access to new patients are alarming,” Townsend added. “We have implemented immediate measures, and we have developed long-term solutions. The health and well-being of Delawareans, and the Delaware economy, cannot afford for us to delay in implementing those solutions, or for us to lack the courage to tackle complex policy and political issues.”
Current solutions that PCP offices are employing include tapping non-physician clinicians. In 2013, only 53 percent of PCP offices employed nurse practitioners or physician assistants to supplement physicians. By 2018, that number climbed to 62 percent of PCP offices.
Improving payment structures for Delaware’s primary care workforce may be another viable solution to supporting these professionals, said James Gill, MD, a family medicine physician in Wilmington Delaware and a member of the Medical Society of Delaware.
“This DHSS study illustrates the poor access to primary care experienced by Delawareans,” Gill said.
“Increasing access to primary care will require increasing payment for primary care services by commercial payers in our state, which is currently 40 percent to 50 percent below the rest of the country,” he concluded. “Senate Bill 227 has begun to move Delaware in that direction, and the Primary Care Collaborative is working to continue the work necessary to reduce the cost of care and improve the quality of care and the health of Delawareans.”