Outpatient primary care physician shortage could worsen as new internists opt for hospital employment

New internists are choosing to practice in hospitals over outpatient centers, making the outpatient physician shortage worse, according to a study published in Annals of Internal Medicine May 17.

Researchers from the American Board of Internal Medicine, the Boston-based Beth Israel Deaconess Medical Center department of medicine and the Center for Healthcare Delivery Science, and Boston-based Harvard Medical School's Department of Health Care Policy used Medicare fee-for-service claims from 2008 to 2018 and annual practice setting types for approximately 70,000 internists certified between 1990 and 2017.

The percentage of internists working in hospitals increased from 25 percent to 40 percent between 2008 and 2018, with a corresponding rise of internists in outpatient settings from 23 percent to 38 percent.

In 2018, 71 percent of new internists practiced in hospital settings, while only 8 percent chose to work on a solely outpatient basis. 

"Outpatient primary care physician shortages will accelerate as outpatient-only physicians begin to retire with few additional mixed practice physicians who have been bolstering the outpatient capacity over the past decade to replace them," Bradley Gray, PhD, senior health services researcher at the American Board of Internal Medicine, said in an email to RevCycleIntelligence.

The Association of American Medical Colleges predicted that primary care will see a shortage of 17,800 to 48,000 physicians by 2034, citing retiring physicians and increasing physician burnout as factors associated with the decreasing number of practicing physicians over time. 

The Resident Physician Shortage Reduction Act of 2021 was introduced by the House of Representatives and the Senate to address the developing shortage, increasing the number of residency positions eligible for graduate medical education payments under Medicare for qualifying hospitals to 2,000 per year from 2023 to 2027.

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