By Linda Carroll

(Reuters Health) – In a little over a decade, the number of patients in the U.S. with primary care providers dropped by 2%, a new study finds.

Between 2002 and 2015, fewer and fewer Americans of all ages, except for those in their 80s, had a primary care provider, researchers report in JAMA Internal Medicine.

While 2% may not seem like a big drop off, “that’s millions and millions of people who no longer have a primary care provider,” said the study’s lead author Dr. David Levine, an associate physician at Brigham and Women’s Hospital in Boston, and an instructor in medicine at Harvard Medical School. In fact, “it’s essentially about the population of New Jersey.”

“It’s a particularly stark decrease among younger folks, particularly those who are healthy,” Levine said, adding that the decline was also dramatic – at nearly 10% – among those who were in their 60s and healthy.

The study team found that, overall, the proportion of U.S. adults with a primary care physician fell from 77% in 2002 to 75% in 2015. Among 30-year-olds, the proportion dropped from 71% to 64% in the same period.

People with three or more chronic health conditions were an exception, and the proportion with a primary care doctor remained relatively stable, the authors note.

For Levine, primary care isn’t about healthy people getting an annual physical, it’s about having a relationship with a particular primary care provider, so that when you do get sick that doctor knows something about you.

“I tell my 20- and 30-year-old patients, ‘I don’t need to see you until you need to see me,'” Levine said. “It makes a big difference having a relationship with a physician even if you’ve met only once. Then the physician has some history on you, and maybe some baseline labs.”

Take the example of someone who has a urinary tract infection, Levine said. “As a physician I’m going to feel much more comfortable treating you over the phone if I have baseline data,” he said. “And if the UTI doesn’t go away – if it becomes a kidney infection or is caused by a multidrug resistant organism – then I can follow-up.”

Beyond that, “(studies have shown) folks who have a primary care provider are much happier with their healthcare than those who don’t,” Levine said. “There is about a 10% boost in patient satisfaction with healthcare when they have a primary care provider.”

To take a closer look at how many patients have a primary care provider, Levine and his colleagues turned to a nationally-representative database of health spending that surveys between 21,915 and 26,509 patients annually about their experiences with healthcare.

The researchers focused on the years 2002 through 2015 and deemed patients to have primary care providers if they answered yes to four questions: Do you have a usual source of care for new health problems? Do you have a usual source for preventive health care? Do you have a usual source for referrals? and, Do you have a usual source for ongoing health problems?

“It’s a very patient-centered definition of primary care,” Levine said.

Given the current system of healthcare, the new findings aren’t necessarily a cause for worry, said Dr. Martin Makary of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, author of “The Price We Pay: What Broke American Health Care – and How to Fix It.”

“With the primary care provider shortage, do we really need every young healthy male coming in to see their doctor regularly?,” Makary said. And even though “relationships are powerful, turnover in primary care is extremely high.”

The real problem, Makary said, is with the traditional fee-for-service billing model and the low value placed on the provision of primary care.

The value of primary care has also been limited due to the fact that most providers can only afford to do very short visits, Makary said. And while primary care providers used to spend a lot of time educating patients, these days people “are bypassing traditional models and educating themselves.”

SOURCE: JAMA Internal Medicine, online December 16, 2019.