Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States

Escarce, José J.; Wozniak, Gregory; Tsipas, Stavros; Pane, Joseph D.; Brotherton, Sarah E.; Yu, Hao

doi:10.1097/mlr.0000000000001523

Cited by 9 publications

(11 citation statements)

References 23 publications

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“…This, in turn, can reduce the supply of new PCPs in nonexpansion states as noted by prior research. 7 Indeed, a recent study published in Medical Care found that the Medicaid expansion was associated with more new general internists choosing to practice in expansion states instead of nonexpansion states. 7 It will be interesting for future studies to examine whether the increased starting pay together with other ACA provisions directly targeting primary care (such as investment in continued development of primary care workforce) 30 enhanced the job satisfaction of PCPs in expansion states, and whether the change in new PCPs' distribution, especially new general internists, ultimately leads to better access to primary care and better health outcomes for people in expansion states.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Studies of the effect of the Medicaid expansion on primary care and behavioral health workforce have also emerged in recent years. [5][6][7] In terms of primary care workforce, a recent study showed that new general internists increasingly chose to practice in expansion states after the expansion was implemented. 7 A qualitative study found that health care organizations in expansion states tried to recruit more primary care providers to meet the higher demand for health care.…”

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confidence: 99%

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Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians

Armstrong

Forte

et al. 2022

Medical Care

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Background: It is well-documented that the Affordable Care Act Medicaid expansion increased health care utilization by low-income Americans. Emerging studies also found that the expansion changed the geographical distribution of new physicians. However, the effect of the expansion on physician compensation has not been studied. Objectives: We aimed to assess how the Medicaid expansion affected the compensation of new primary care physicians (PCPs) and whether the effect differed by specialty, gender, and geography. Research Design: We used a quasiexperimental difference-in-differences design to assess changes in compensation for new PCPs from before to after the Medicaid expansion in states that expanded Medicaid compared with states that did not expand. Subjects: Our study included 2003 new PCPs who responded to the Survey of Residents Completing Training in New York between 2009 and 2018. Measures: Our primary outcome was respondents’ self-reported starting salary for their first year of practice. Our secondary outcomes were respondents’ self-reported additional anticipated income and incentives they received for accepting the job offer. Results: We found that starting salaries for new PCPs, especially new general internists and family physicians, grew faster in expansion states than in nonexpansion states. In addition, we found that the expansion was associated with a statistically significant increase in receiving additional anticipated income as part of the compensation package for new PCPs practicing in rural areas.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians

Armstrong

Forte

et al. 2022

Medical Care

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“…Previously, smart communities have been studied primarily from the aspects of advanced computer technologies [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ], design of operating modes [ 16 , 17 , 18 , 19 ], and governance in the implementation of the smart community [ 4 , 5 , 20 , 21 , 22 , 23 ]. Moreover, there are many kinds of studies on residents’ demands, most of which concentrate on a specific aspect, such as energy demand [ 24 , 25 ], elderly care services [ 26 , 27 ], medical care services [ 28 , 29 ], urban green space [ 30 , 31 ], public sports services [ 32 ], and housing demand [ 30 , 33 ]. However, relevant studies still suffer some limitations, which are embodied in the following three aspects.…”

Section: Introductionmentioning

confidence: 99%

Demands for Community Services and Associated Factors among Residents in Smart Communities: A Case Study of Xuzhou City

Chen

Wang

et al. 2023

IJERPH

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Smart community enables a sustainable and livable community future, in which residents’ demands play an important role in its success. Though great efforts have been made to encourage residents’ participation in the implementation of smart communities, inefficient service supply still exists. Thus, this study aimed to classify residents’ demands for community services in smart communities and to explore relevant influencing factors based on the developed conceptual framework. Data from 221 respondents in Xuzhou city of China were analyzed by using binary logistic regression. The results indicated that more than 70% of respondents had demands for all community services in smart communities. Moreover, the demands were influenced by distinct factors, including sociodemographic characteristics, living characteristics, economic characteristics, and individual attitude characteristics. The types of community services in smart communities are clarified and fresh insights are provided into associated factors related to residents’ demands for these services in this study, through which enhanced provision of community services and effective implementation of smart communities can be achieved.

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“…A recent study in Medical Care 8 assessed whether the fact that some states expanded Medicaid while other did not influenced the choice of states where new physicians, defined as those just completing graduate medical education (GME), in 8 specialty groups established their first practices. The study found that higher numbers of new general internists established their first practices in expansion states than would have if every state had expanded, meaning that expansion states gained new general internists, while nonexpansion states lost them.…”

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The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists

Escarce¹,

Wozniak

Tsipas

et al. 2022

Medical Care

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Background: A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them.Objective: The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them.Research Design: We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009-2019 data from the AMA Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion.Subjects: A total of 32,102 new general internists.Results: Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203-540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states.Conclusions: States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.

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Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States

Abstract: Supplemental Digital Content is available in the text.

Cited by 9 publications

References 23 publications

Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians

Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians

Demands for Community Services and Associated Factors among Residents in Smart Communities: A Case Study of Xuzhou City

The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists

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