Background
In
the shadow of the COVID-19 pandemic, family physicians are concerned about
their ability to keep practices open despite stay-at-home orders issued by
governors, patient concerns about visiting doctors’ offices, limited access to
personal protective equipment, and potentially being reassigned to
hospital-based care. These and other factors may lead to drastic reductions in
practice hours and staff.
Methodology
The
"Coronavirus Pandemic-Related Potential Family Medicine Office Closures
and Economic Impact, April through June 2020" visualization (https://healthlandscape.org/covid19/) presents a “what-if” family physician
attrition scenario. Data sources include the National Plan and Provider
Enumeration System (NPPES)[1],
the American Medical Association (AMA) Physician Economic Impact Study[2]
and the Robert Graham Center Social Deprivation Index (SDI)[3].
Initial family physician counts by U.S. county were derived from the February
2020 NPPES including all Family Medicine typologies. Initial total number of
jobs supported by the physicians and the amount of wages and salaries were
derived from the AMA Physician Economic Impact Study. We used estimates shown
in Table 3 in each of the state reports to calculate the number of jobs per
family physician and the wages and salaries attributable to family physicians. State-by-state
reports are available online[4]. These
multipliers were then applied to counts of family physicians from the NPPES and
summed to get estimated Jobs and Wages & Salaries numbers.
The
model assumes 3-4% attrition (loss) of individual family physicians each week.
In the model, each county loses a minimum of three percent of its family
physicians per week. An additional amount of attrition is factored in based on
SDI scores which range from 0 to 100, with larger scores indicating more
deprivation. SDI is included because populations with higher SDI scores may
have higher community risk. No additional attrition above the 3% is included
for counties that have an SDI score of 0, while a county with an SDI score of
100 will have the maximum level of 4% attrition. For example, attrition rates
for counties with an SDI score of 43 were adjusted to 3.43%.
Results
On
March 31, 2020, there were 138,707 family physicians, whose practices supported
1,872,907 jobs, including those of the physicians, for a total of $154,283,373,121
in wage and salaries. At that time, 750 counties had population to family
physician ratios greater than 3,500:1. Using constant losses across the time
period, there will be 58,025 fewer family physicians working in their
practices, resulting in a total job loss of 784,133 and lost wages and salaries
of $64,645,325,573. Furthermore 1,841 counties would have population to family
physician ratios greater than 3500:1.
About HealthLandscape
HealthLandscape develops,
administers, and markets geospatial analysis software tools and professional
services. HealthLandscape has extensive experience in GIS applications relating
to health centers and primary care and works closely on all projects as a team.
Mark Carrozza, MA; Jene Grandmont, MA; Dave Grolling, MS; Jessica McCann, MS;
Jennifer Rankin, PhD; Michael Topmiller, PhD.
About the Robert Graham Center
The Robert Graham Center aims to
improve individual and population healthcare delivery through the generation or
synthesis of evidence that brings a family medicine and primary care
perspective to health policy deliberations from the local to international
levels. Jack Westfall, MD.
[1] https://download.cms.gov/nppes/NPI_Files.html.
Data accessed February 17, 2020.
[2] https://www.physicianseconomicimpact.org/.
Accessed March 16, 2020.
[3] https://www.graham-center.org/rgc/maps-data-tools/sdi/social-deprivation-index.html.
2017 SDI uses data from 2013-2017 American Community Survey.
[4]
For an example, see the Ohio report: https://www.physicianseconomicimpact.org/pdf/FullStateReports/OH-Study.pdf.
