Ensuring that everyone in the U.S. has access to high-quality primary care, as recommended by the National Academies of Sciences, Engineering and Medicine (NASEM),27 requires a robust and stable primary care workforce. However, the United States currently faces a concerning shortage of primary care physicians, as well as an inequitable distribution of primary care clinicians (including physicians, nurse practitioners [NPs], and physician assistants [PAs]) across the country.43)
The primary care physician workforce in the U.S. is shrinking,44 with a projected shortage unable to meet patient demand by 2035.45 The proportion of health care trainees who choose to focus on primary care has decreased in recent years, and primary care training disproportionally takes place in hospitals rather than in the community settings where primary care services mainly occur.27,44 In addition, there is wide variation in the proportion of primary care clinicians serving different areas across the United States, resulting in growing gaps in access to care in medically underserved communities.27
Unfortunately, the COVID-19 public health emergency exacerbated challenges with primary care workforce well-being, including increased workload, work-related stress, and emotional distress.46 In 2022, more than half of family physicians reported symptoms of burnout.47 In addition to the personal toll on physicians and their families, burnout has been found to lead to poorer quality of care, lower patient satisfaction, and decreased patient safety.47-49 Low physician well-being, professional satisfaction and high burnout leads some clinicians to reduce their hours or leave practice altogether, further exacerbating workforce shortages.47
Research is needed to better understand how to effectively expand and diversify the primary care workforce, mitigate burnout, and to examine how to best support primary care teams in communities throughout the United States. AHRQ has identified primary care workforce as a topic area of interest, although investments in 2021 and 2022 were limited to a small number of grants (including a conference), as described in this section. Studies that measure, track, and contribute to understanding the experience of the primary care workforce are necessary to ensure access to quality primary care.
Grants
Four AHRQ primary care grants actively funded during FYs 2021 and 2022 were focused mainly on the primary care workforce. This included two R03s (Small Research Grants), one R13 (Support for Conferences and Scientific Meetings), and one K08 (Mentored Clinical Scientist Development Award). In addition to these four grants, one other grant included primary care workforce as a component, and is described in the Healthcare Systems and Infrastructure section.
Below are tables, organized by two subtopics, which include short summaries of the four studies focused mainly on the primary care workforce. Subtopics include expanding the primary care workforce with nurse practitioners and measuring individual and team factors affecting the primary care workforce.
Grants with a focus on health equity are indicated with this icon.
Expanding the Primary Care Workforce With Nurse Practitioners
Two studies look at expanding the primary care workforce with a focus on nurse practitioners, as described in the following table.
| Advancement of Research on Nurse Practitioners (ARNP): Setting a Research Agenda (R13) |
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PI: Lusine Poghosyan Organization: Columbia University Health Sciences; School of Nursing; Other Health Professions Organizes a research conference to advance research on NPs in primary care. The focus of the conference is on identifying barriers and facilitators affecting the NP workforce, strategies to overcome those challenges, and the development of a research agenda to produce evidence to support the expansion of NPs in primary care. |
The Role of Nurse Practitioners in Improving Access to Primary Care (R03) |
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PI: Hannah Toby Neprash Organization: University of Minnesota; School of Public Health; Public Health and Preventative Medicine Develops a national database of all-payer claims and electronic health record data to examine how much adding nurse practitioners to primary care teams increases access to care, particularly for patient populations that have traditionally faced barriers to access. |
Measuring Individual and Team Factors Affecting the Primary Care Workforce
Two studies focus on new measures of methods for measuring individual and team factors affecting the primary care workforce.
| Validation of the Primary Care Team Creativity Tool (PCTC) (R03) |
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PI: Yuna Swatlian Hiratsuka Lee Organization: Columbia University Health Sciences; School of Public Health; Public Health & Preventive Medicine Validates a newly developed survey tool focused on measuring primary care team creativity, measuring how well teams work together and generate novel and useful strategies to solve complex challenges in primary care. |
| Development and Validation of a Prediction Model to Address Physician Burnout (K08) |
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PI: Daniel Tawfik Organization: Stanford University; Domestic Higher Education Develops and validates a prediction model that uses existing operational data to identify primary care clinics at high-risk for clinician burnout. |
Initiatives and Resources
AHRQ did not have any new initiatives or resources related to primary care workforce during 2021 and 2022.
