PURPOSEWe sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act. METHODSIn this projection of workforce needs, we used the Medical Expenditure Panel Survey to calculate the use of offi ce-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfi le to calculate the number of primary care physicians and determine the number of visits per physician. The main outcomes were the projected number of primary care visits through 2025 and the number of primary care physicians needed to conduct those visits.RESULTS Driven by population growth and aging, the total number of offi ce visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. After incorporating insurance expansion, the United States will require nearly 52,000 additional primary care physicians by 2025. Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3% increase in the current workforce.CONCLUSIONS Population growth will be the greatest driver of expected increases in primary care utilization. Aging and insurance expansion will also contribute to utilization, but to a smaller extent. INTRODUCTIONW ith passage of the Affordable Care Act (ACA), health insurance coverage will expand to an additional 34 million people in the United States.1 After Massachusetts mandated health insurance in 2006, primary care wait times increased, even though the state has the second highest ratio of primary care physicians to population of any state and a robust network of community health centers 2,3 Reports statewide of physicians with limited capacity to see additional patients prompted Dr Mario Motta, President of the Massachusetts Medical Society, to declare that universal coverage does not equal universal access.4 Insurance expansion is expected to have a greater impact nationally, as the use of services by the nation's 46.3 million uninsured is likely to rise.5 President Obama has recognized this challenge and called for an immediate and long-term expansion of the nation's primary care physicians, nurse practitioners, and physician assistants. Our aim is to explain the potential size of this growth.Prior research has consistently demonstrated the association between having insurance and increased health services use. The Association of American Medical Colleges (AAMC) projected that universal coverage will increase use of all physicians by 4%, 6 while the Bureau of Health Professions projected a 5.2% increase.7 Our analysis uses population-based nationally representative utilization data to project the number of primary care physicians needed to address expected increases in use due to insurance expansion. These data can be c...

BACKGROUND.There are limited effective treatment options available and a poor 5‐year survival for patients with inoperable neuroendocrine liver metastases (NETLMs). In this study, the authors prospectively assessed the safety and efficacy of treatment with yttrium 90 (90Y) radioactive microspheres for patients with unresectable NETLMs.METHODS.Radioactive 90Y resin microspheres (selective internal radiation [SIR‐Spheres]) were administered through a temporarily placed percutaneous hepatic artery catheter concomitantly with a 7‐day systemic infusion of 5‐fluorouracil to patients with progressive, unresectable NETLMs. Patients were monitored prospectively, and the response to treatment was measured by using cancer markers and tumor size on computed tomography imaging studies.RESULTS.Thirty‐four patients (22 men) with a mean age 61 years (range, 32‐79 years) who had unresectable NETLMs were treated between December 2003 and December 2005. The mean (±standard error) follow‐up was 35.2 ± 3.2 months. The site of the primary neuroendocrine tumor was the bronchus in 1 patient, the medullary thyroid in 2 patients, gastrointestinal in 15 patients, the pancreas in 8 patients, and of unknown origin in 8 patients. The tumors were classified as vipoma (1 tumor), somatostatinoma (1 tumor), glucagonoma (2 tumors), large cell (3 tumors), carcinoid (25 tumors), and of unknown origin (2 tumors). Complications after 90Y radioembolization included abdominal pain, which was mild to severe; nausea and fever; and lethargy that lasted from 1 week to 1 month. Two patients developed biopsy‐proven radiation gastritis, 1 patient developed a duodenal ulcer, and there was 1 early death from liver dysfunction and pneumonia. Subjective changes from recorded baseline hormone symptoms were reported every 3 months. Symptomatic responses were observed in 18 of 33 patients (55%) at 3 months and in 16 of 32 patients (50%) at 6 months. Radiologic liver responses were observed in 50% of patients and included 6 (18%) complete responses and 11 (32%) partial responses, and the mean overall survival was 29.4 ± 3.4 months). In patients who had evaluable chromogranin A (CgA) marker levels, there was a fall in CgA marker levels after 90Y radioembolization in 19 patients (26%) at 1 month, in 19 patients (41%) at 3 months, in 15 patients (43%) at 6 months, in 11 patients (42%) at 12 months, in 8 patients (38%) at 24 months, and in 3 patients (46%) at 30 months.CONCLUSIONS.In this open study of 34 patients, the results demonstrated that radioembolization with 90Y resin microspheres can achieve relatively long‐term responses in some patients with nonresectable NETLMs. Cancer 2008. © 2008 American Cancer Society.

Background: Despite clear evidence demonstrating the influence of social determinants on health, whether and how clinicians should address these determinants remain unclear. We aimed to understand primary care clinicians' experiences of administering a social needs screening instrument.Methods: Using a prospective, observational design, we identified patients living in communities with lower education and income seen by 17 clinicians from 12 practices in northern Virginia. Before office visits, patients completed social needs surveys, which probed about their quality of life, education, housing, finances, substance use, transportation, social connections, physical activity, and food access. Clinicians then reviewed the completed surveys with patients. Concurrently, clinicians participated in a series of learning collaboratives to consider how to address social needs as part of care and completed diary entries about how knowing the patient's social needs influenced care after seeing each patient.Results: Out of a total of 123 patients, 106 (86%) reported a social need. Excluding physical activity, 71% reported a social need, although only 3% wanted help. Clinicians reported that knowing the patient had a social need changed care delivery in 23% of patients and helped improve interactions with and knowledge of the patient in 53%. Clinicians reported that assessing social needs is difficult and resource intensive and that there were insufficient resources to help patients with identified needs.

PURPOSE The purpose of this study was to calculate the projected primary care physician shortage, determine the amount and composition of residency growth needed, and estimate the impact of retirement age and panel size changes. METHODSWe used the 2010 National Ambulatory Medical Care Survey to calculate utilization of ambulatory primary care services and the US Census Bureau to project demographic changes. To determine the baseline number of primary care physicians and the number retiring at 66 years, we used the 2014 American Medical Association Masterfile. Using specialty board and American Osteopathic Association figures, we estimated the annual production of primary care residents. To calculate shortages, we subtracted the accumulated primary care physician production from the accumulated number of primary care physicians needed for each year from 2015 to 2035. RESULTSMore than 44,000 primary care physicians will be needed by 2035. Current primary care production rates will be unable to meet demand, resulting in a shortage in excess of 33,000 primary care physicians. Given current production, an additional 1,700 primary care residency slots will be necessary by 2035. A 10% reduction in the ratio of population per primary care physician would require more than 3,000 additional slots by 2035, whereas changing the expected retirement age from 66 years to 64 years would require more than 2,400 additional slots. CONCLUSIONSTo eliminate projected shortages in 2035, primary care residency production must increase by 21% compared with current production. Delivery models that shift toward smaller ratios of population to primary care physicians may substantially increase the shortage. INTRODUCTIONT he demands of an expanding, aging, and increasingly insured population have created concern about the sufficiency of our health care workforce. Already there are rising costs, unnecessary treatment, and undesirable levels of emergency department visits. [1][2][3] Provisions in the Patient Protection and Affordable Care Act (ACA) support primary care physicians with the aspiration that a reinvigorated primary care workforce can "bend the cost curve."4 Initiatives, such as Family Medicine for America's Health, aim to develop the next generation of primary care physicians but lack guidance regarding how training will need to change. 108Prior supply projections have assumed production will remain constant and estimated new primary care physicians based on overall physician supply growth. For instance, HRSA estimated that by 2020, the number of primary care physicians would increase 8% by assuming that 31.9% of new physicians will be primary care physicians. 10,11 There is no reason to believe that production of primary care physicians will remain static, however. According to Chen et al, only 25.2% of all residents graduating between 2006 and 2008 practiced primary care in 2011. 12 The same study estimated 40% of internal medicine residents do not subspecialize, a finding similar to figures from the AAMC.11 Simultane...