Primary Care Physicians in Alabama

This project studies the demographics and the geometric distribution of primary care physicians (PCPs) in Alabama, with a particular emphasis on the rural/urban dichotomy. Most importantly, we also consider ways of measuring the need for PCPs in healthcare service areas using a supply and demand model that is based on the demographics of the population in the service area.

Primary Care Physicians

The Office of Family Health, Education, and Research has a rather strict definition of a Primary Care Physician (PCP) based on the traditional model of continuity of care. A great deal of our work goes into identifying those physicians practicing primary care and determining the extent of their practice. For this study, a PCP is a physician practicing in

• Family or General Medicine
• Internal Medicine
• Pediatrics

For some purposes, OB/Gyn physicians are also considered primary care, but we study these physicians in another project and so do not consider them here. We exclude physicians in one of the specialties above who are not practicing primary care. For example, we do not count

• Hospitalists
• ER Physicians
• Physicians working in urgent care clinics
• Physicians who specialize in pain management, sports medicine, etc.
• Physicians working full time as faculty or in administration.

Ultimately, we do not want to count the PCPs themselves, but rather Full-Time Equivalent (FTE) primary care physicians. We define an FTE as a PCP who works 40 hours per week in direct patient care for 48 weeks per year. So a semi-retired physician would count as a fractional FTE. Other examples are

• Resident: 0.1 FTE
• Part-time faculty Member: 0.5 FTE

Demographics

In this project we study the demographics of PCPs, again with emphasis on rural PCPs and urban PCPs.

• Gender
• License Type
• Primary Care Sepcialty
• Age
• Workload

Geographic Distribution

We are particularly interested in how PCPs are distributed geographically. We study the distribution through graphs and interactive tables by

• Communites
• Counties
• Primary Care Service Areas

Computing PCP Need

We give two different models for determining the number of PCP FTEs needed for a service area. Both use estimates of primary care need per year in a service area based on the age distribution in the service area, and estimates of primary care service that an FTE can provide. One model uses visits and the other uses time.

Limitations

There are a number of limitations to this study, particularly with regard to the PCP need computations:

• Much of the data that we rely on (see Sources below) are self-reported and may not be accurate.
• The determination of the FTE fraction for a PCP is usually just an approximation.
• Determining the practice location of a PCP is more dificult than it might seem, since many PCPs have more than one practice location.
• Other models for PCP need lead to different conclusions.
• Insurance and other barriers to primary care have not been considered.
• Assumptions about FTE supply (hours per day, days per week, weeks per year) are averages.
• Assumptions about FTE demand in a service area (visits per year, minutes per year) are also averages.
• Nurse Practitioners, Physician Assistants and other mid-level primary care providers have not been considered.
• Telehealth and other technologies for remote delivery of primary care have not been considered.

Sources

• Physician Data: Alabama Board of Medical Examiners
• Demographic Data: US Census Bureau
• Filtering: Internet searches, personal contacts