NEW CASTLE (Jan. 2, 2019) – The number of full-time equivalent primary care physicians providing direct patient care in Delaware in 2018 declined about 6 percent from 2013, a trend that resulted in a slightly lower percentage of physicians statewide who are accepting new patients, according to a new University of Delaware study of the primary care physician workforce commissioned by the Department of Health and Social Services (DHSS).
The study, done by UD’s Center for Applied Demography & Survey Research, also found that the reduction in primary care physicians likely will continue, with a declining percentage of primary care physicians expecting to be active in five years, especially in Kent County. Kent has the highest percentage (25 percent) of physicians 65 and older, compared with Sussex County (16 percent) and New Castle County (13 percent). Only 60 percent of primary care physicians in Kent County reported that they will be active in five years, compared to 70 percent in Sussex County and 78 percent in New Castle County.
Despite the workforce trends, the UD study found that there are a sufficient number of primary care physicians in Delaware, “although their location and specialty is probably not optimal.” In 2018, there were 815 individual primary care physicians practicing in Delaware, down from 862 in 2013, and a full-time equivalent of 662 physicians statewide in 2018 vs. 707 in 2013. The study found that the 2018 numbers are at the upper range of what is desirable. Both Kent County – 2,069 patients per primary care physician – and Sussex County – 2,014 patients per physician – are above the 2,000-to-one ratio used by the U.S. Health Resources and Services Administration (HRSA) to designate shortage areas.
DHSS Secretary Dr. Kara Odom Walker, a board-certified family physician, said the trends point to the need to strengthen the dwindling primary care workforce in Delaware.
“The best preventive care and the most cost-effective care is provided by a strong and coordinated primary care workforce,” Secretary Walker said. “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 diseases. 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.”
State Sen. Bryan Townsend and Dr. Nancy Fan, Chair of the Delaware Health Care Commission, are Co-Chairs of the Primary Care Collaborative, which is working on long-term solutions to support primary care in the state. The collaborative was created through Senate Bill 227, which aimed to strengthen primary care through a series of changes, including requiring insurers to reimburse primary care physicians and other front-line practitioners at the Medicare rate for the next three years. The collaborative, which has been meeting since September, is expected to issue its long-term recommendations by Jan. 8.
“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. 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.”
“This survey is very timely and demonstrates with supporting data the primary care physician crisis currently in Delaware,” said Dr. Nancy Fan, Chair of the Delaware Health Care Commission and an obstetrician/gynecologist in Wilmington. “Recognizing that primary care is foundational to effective, quality health care, the Health Care Commission is working through the Primary Care Collaborative to develop policy recommendations that will strengthen and maintain the current workforce and increase attractiveness of practice in Delaware for the future physician workforce. If something is not done immediately, these numbers will only get worse.”
“This DHSS study illustrates the poor access to primary care experienced by Delawareans,” said Dr. James Gill, a family medicine physician in Wilmington and a member of the Medical Society of Delaware who advocated for Senate Bill 227. “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. 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.”
Among the other findings in the Primary Care Physicians in Delaware 2018 Survey:
- In 2018, accounting for the time that primary care physicians offer direct patient care, the estimated full-time equivalent (FTE) was 662 physicians, with 461 FTEs in New Castle County, 89 in Kent and 112 in Sussex.
- About 60 percent of Delaware’s physicians went to high school in the region; over half graduated from a medical school in the region; and about 80 percent completed their medical residency in the region.
- The breakdown by gender statewide is 52.9 percent male and 47.1 percent female.
- Delaware has a disproportionately low percentage of African-American (6.6 percent) and Hispanic (4.3 percent) primary care physicians statewide, compared with the state’s general population of 22.8 percent African-American and 18.1 percent Hispanic/Latino.
- About 82 percent of physicians were accepting new patients in 2018, compared with 86 percent in 2013, but the proportion accepting new Medicare patients (72 percent) and new Medicaid patients (78 percent) was lower.
- Average wait times statewide for new patients was 23 days in 2018, compared with 32 days in 2013, and six days for established patients in 2018 vs. 17 days in 2013.
- The percentage of primary care physicians who employed non-physician services – advanced practice nurses, physician assistants and others – climbed to about 62 percent in 2018, up from 56 percent in 2013.
- About 80 percent of physicians participated in a pay-for-performance reimbursement model including shared savings (34 percent), shared risk (19 percent), capitation model (14 percent), and concierge model (6 percent).
Data collection for the Primary Care Physician in Delaware 2018 Survey was done during the spring and summer of 2018, with 2,533 physicians contacted by mail who have an active license with a Delaware address or an address with a ZIP code adjacent to Delaware. Of those contacted, 957 responded and provided usable data. Primary care physicians practice in one of five specialties: family practice, general practice, internal medicine, pediatrics or obstetrics/gynecology.
Download the study here from the DHSS website.