INDUSTRY ANALYSIS

Primary Care Physician (PCP) Switching in the U.S. for the General Public and for 64+ Americans/Medicare Segment

Challenges in Selecting a New PCP: 64 + Years/Medicare Segment

The challenges that Americans who are aged 64+ are facing when selecting a new PCP include ageism in the healthcare sector and issues in the accessibility of PCPs in rural America. On the other hand, the challenges the general public faces when selecting a new PCP includes a lack of choice and a shortage of primary care physicians. A detailed overview of the research findings follows below.

1. Ageism in the Healthcare Sector

  • Ageism is ” the stereotyping and discrimination against individuals or groups on the basis of their age. Ageism can take many forms including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs.”
  • In the American healthcare system, ageism is a challenge that people aged 65 years and above face when selecting a new PCP because there hasn’t been a major change in how doctors are trained and in their attitudes towards older patients.
  • As a result, it is harder for older patients to find a PCP that will fully match their medical needs as they continue to age. The fact that medication-related problems are one of the top five causes of death for Americans aged 65 and older shows that compatibility between PCPs and the needs of older patients seeking new providers is very low.
  • Additionally, 1 in 3 seniors that take more than five medications will have at least one bad drug reaction annually and a third of them will require medical attention while people aged over 65 are 2.5 times more likely to require a visit to the emergency room for a bad drug reaction than younger people.
  • The above statistics show that ageism in the healthcare system can be a major challenge when people aged 64 and above go out looking for new PCPs.

2. Accessibility of PCPs in Rural Communities

  • Out of a total of 5,198 community hospitals in the United States, 3,377 hospitals are in urban communities while 1,821 hospitals are in rural communities.
  • As for the population of rural communities in the country, 1 in 5 older Americans live in rural areas while a large number of them are concentrated in states where over 50% of their older residents live in rural areas.
  • According to the American Community Survey (ACS) data for the period 2012-2016, out of 46.2 million older people in the United States, 10.6 million resided in areas designated as rural.
  • From the above statistics, it is evident that accessibility to PCPs is another challenge that people aged over 64 years face when looking for new PCPs. The fact that most older people in the United States reside in rural communities that have a lower number of hospitals than urban communities clearly highlights this problem.

Challenges in Selecting a New PCP: General Public

1. Lack of Choice

  • When people in the general population go out to look for new PCPs, they usually face a problem in finding a PCP that can best cater to their health needs. This is because, in the United States, each “general practitioner has a particular way of working with patients and promoting their health, which is more compatible with some patients than others.”
  • Consequently, a lack of choice when it comes to selecting a new PCP is a real challenge that people face in the American healthcare sector. In some areas, especially in rural communities, there is a significant lack of choice that results in patients not receiving all the benefits of primary care as they don’t have access to a PCP that is well suited to meet their health needs.
  • This absence of choice leads to people choosing the next best PCP and this can affect the quality of healthcare services people are exposed to as a mismatch between a PCP and patient may mean the patient will not receive all the healthcare benefits of having a primary care provider.

2. Shortage of Primary Care Physicians

  • According to the Washington Post, the United States is expected to have a shortage of PCPs within the next decade. The reason behind this is that the graduates of American medical schools are less likely to choose to specialize in medical fields that are related to primary care.
  • In 2019, a record-high number of PCP positions were offered through the National Resident Matching Program that was known as the Match. In 2020, this was not the case because “the percentage of primary care positions filled by fourth-year medical students was the lowest on record.
  • The three key primary care fields are — internal medicine, family medicine, and pediatrics. In 2019, around 8,116 positions in internal medicine were offered via the Match program, but only 41.5% of the positions were filled by seniors pursuing medicine in U.S. schools.
  • The Association of American Medical Colleges predicts that by 2032 there will be a shortage of between 21,100 and 55,200 PCPs. This shortage which is already being experienced poses a challenge to people that are trying to identify a new PCP because the number of physicians is declining at a steady rate and finding a PCP that is best suited to a patient’s needs will continue to become harder.

Considerations When Selecting/Evaluating New PCP: 64 + Years/Medicare Segment

The considerations that patients aged over 64 years/the medicare segment make when selecting/evaluating a new PCP includes the location of the PCP offices and whether the PCP accepts medicare or not. On the other hand, the considerations that the general public makes when selecting/evaluating a new PCP include the fit of the PCP to the health needs of the patients and the gender of the PCP. A detailed overview of the research findings follows below.

1. Location of PCP Offices

2. PCPs that Accepts Medicare

Considerations When Selecting/Evaluating New PCP: General Public

1. PCP Fit to Patient Healthcare Needs

2. Gender of the PCP

Factors that Influence/Discourage PCP Switching: 64 + Years/Medicare Segment

The factors that influence/discourage PCP switching in the population group of people aged over 64 years/the medicare segment include the quality of the relationship between PCPs and patients, the need for specialized care for older patients, and the medicare status of the PCP. On the other hand, the factors that influence/discourage PCP switching for the general public include technological advancement in the healthcare sector, a patient’s healthcare plan, and the level of patient satisfaction with PCP healthcare services. A detailed overview of the research findings follows below.

1. Quality of Relationship Between PCP and Patient

2. Need for Specialized Care

3. Medicare Status of the PCP

Factors that Influence/Discourage PCP Switching: General Public

1. Technological Advancements

  • According to the Telehealth Index: 2017 Consumer Survey, 20% of consumers or 50 million consumers would switch “to a PCP that offers video visits if another PCP in their area offers them.”
  • This results from a telehealth survey show that a key factor that influences PCP switching in the United States is the technological advancements that are present in the American healthcare sector.
  • Patients in the general population have an interest in using technology to communicate with PCPs as 65% of respondents to the above survey noted that they were interested in seeing their PCP over video technology.
  • This factor influences PCP switching within the general population because consumers are out searching for more convenient access to healthcare and they are also willing to switch to providers that offer telehealth for health needs that include chronic conditions and post-discharge follow-ups.

2. Patient’s Healthcare Plan

3. Patient Satisfaction with PCP Healthcare Services

Impact of COVID on PCP Switching: 64 + Years/Medicare Segment and General Public

The impacts of COVID on PCP switching in the population group of people aged over 64 years/the medicare segment and the general population include increased switching to PCPs that also offered telehealth and telemedicine services and a decrease in PCP business. A detailed overview of the research findings and research strategy follows below.

1. Switch to PCP Telehealth Providers

2. Decrease in PCP Business

  • The COVID pandemic resulted in decreased business for PCP businesses as they “actively discouraged patients from coming into the office for routine care to prevent the spread of COVID.”
  • Even before the pandemic, PCPs were on a steep decline dropping by 24.2% over the 2008-2016 period. In this period, visits to alternative care sites such as emergency departments and retail medical clinics increased by 46.9%.
  • From the above statistics, it was concluded that the COVID pandemic negatively impacted PCP businesses by resulting in decreased activity in the market including PCP switching.
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