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At the same time the Medicare population is growing, the number of family practice (FP) physicians and the number of procedures they perform are decreasing, according to a new analysis in Annals of Family Medicine.
“The reasons might represent a changing scope of family practice, increasing referrals, shifting tasks to [physician assistants] and [nurse practitioners], or some combination,” wrote the authors, led by Robert McKenna, DMSc, MPH, PA-C, with Marshall B. Ketchum University, Fullerton, California. But understanding the reasons may be important to improve training programs.
The Council of Academic Family Medicine (CAFM) in 2014 addressed variability in how FPs perform procedures with a consensus statement on 44 procedures FPs should be competent to perform after a family medicine residency and 24 more for which residency programs should offer training.
Researchers wanted to see how often the procedures were being done so they performed a retrospective, observational study of the Medicare Part B cohort to understand how often FPs report CAFM-recommended procedures in an outpatient setting. They used data from 2014 to 2021, the most recent years for which data were available, and modified the list of procedures for Medicare beneficiaries to match with Current Procedural Terminology codes.
Procedures Dropped by a Third in 8 Years
For the 8 years ending in 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs who filed them, according to the paper. However, the number of FPs who treat Medicare beneficiaries has remained relatively stable. Almost all procedures performed were for the skin; musculoskeletal; eyes, ears, nose, and throat; and pulmonary categories.
There was a 17% decrease in every category of modified CAFM procedures between 2014 and 2019 before the pandemic.
Concurrently, the U.S. Bureau of Labor Statistics reported a 7% decrease in clinically active FPs from 2013 to 2022; 100,940 FPs were employed clinically in 2022. The Association of American Medical Colleges estimates a shortage of 17,800-48,000 primary care physicians by 2034.
“In 2021, the number of Medicare Part B claims by FPs for all [modified] CAFM outpatient procedures was reported by 12% of these clinicians and represented less than 1% of all CPT claims submitted,” the researchers wrote.
“Meanwhile, the 17% of Americans aged [at least] 65 years is projected to represent 20% of the U.S. population by 2030,” the authors pointed out.
The reasons for the decrease in procedures need further study, the authors said. From 2010 to 2020, there was a 30% and 47% increase in the employment of PAs and NPs, respectively, across all specialties, many employed in primary care. And 42% and 56% of family physicians reported working with PAs and NPs, respectively, from 2014 to 2018, according to the paper.
One explanation is a shifting of roles. “NPs and PAs might increasingly serve as proceduralists, freeing FPs to focus on other aspects of their practice such as complex chronic disease management or annual wellness visits,” the authors wrote.
It’s also possible that more Medicare-eligible Americans are being referred to various specialists such as urologists, gynecologists, and cardiologists, they speculated, adding that, “because demographic trends show an increasingly older population, family medicine training programs might need to adjust to meet this change.”
Among the limitations of the data are that publicly available Medicare data are limited to the approximately 60% of beneficiaries who are traditional Part B enrollees. Those enrolled in Medicare Advantage plans were excluded.
The work was supported in part by a Small Research Grant from the American Academy of Physician Associates in 2022. The authors reported no relevant financial relationships.
At the same time the Medicare population is growing, the number of family practice (FP) physicians and the number of procedures they perform are decreasing, according to a new analysis in Annals of Family Medicine.
“The reasons might represent a changing scope of family practice, increasing referrals, shifting tasks to [physician assistants] and [nurse practitioners], or some combination,” wrote the authors, led by Robert McKenna, DMSc, MPH, PA-C, with Marshall B. Ketchum University, Fullerton, California. But understanding the reasons may be important to improve training programs.
The Council of Academic Family Medicine (CAFM) in 2014 addressed variability in how FPs perform procedures with a consensus statement on 44 procedures FPs should be competent to perform after a family medicine residency and 24 more for which residency programs should offer training.
Researchers wanted to see how often the procedures were being done so they performed a retrospective, observational study of the Medicare Part B cohort to understand how often FPs report CAFM-recommended procedures in an outpatient setting. They used data from 2014 to 2021, the most recent years for which data were available, and modified the list of procedures for Medicare beneficiaries to match with Current Procedural Terminology codes.
Procedures Dropped by a Third in 8 Years
For the 8 years ending in 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs who filed them, according to the paper. However, the number of FPs who treat Medicare beneficiaries has remained relatively stable. Almost all procedures performed were for the skin; musculoskeletal; eyes, ears, nose, and throat; and pulmonary categories.
There was a 17% decrease in every category of modified CAFM procedures between 2014 and 2019 before the pandemic.
Concurrently, the U.S. Bureau of Labor Statistics reported a 7% decrease in clinically active FPs from 2013 to 2022; 100,940 FPs were employed clinically in 2022. The Association of American Medical Colleges estimates a shortage of 17,800-48,000 primary care physicians by 2034.
“In 2021, the number of Medicare Part B claims by FPs for all [modified] CAFM outpatient procedures was reported by 12% of these clinicians and represented less than 1% of all CPT claims submitted,” the researchers wrote.
“Meanwhile, the 17% of Americans aged [at least] 65 years is projected to represent 20% of the U.S. population by 2030,” the authors pointed out.
The reasons for the decrease in procedures need further study, the authors said. From 2010 to 2020, there was a 30% and 47% increase in the employment of PAs and NPs, respectively, across all specialties, many employed in primary care. And 42% and 56% of family physicians reported working with PAs and NPs, respectively, from 2014 to 2018, according to the paper.
One explanation is a shifting of roles. “NPs and PAs might increasingly serve as proceduralists, freeing FPs to focus on other aspects of their practice such as complex chronic disease management or annual wellness visits,” the authors wrote.
It’s also possible that more Medicare-eligible Americans are being referred to various specialists such as urologists, gynecologists, and cardiologists, they speculated, adding that, “because demographic trends show an increasingly older population, family medicine training programs might need to adjust to meet this change.”
Among the limitations of the data are that publicly available Medicare data are limited to the approximately 60% of beneficiaries who are traditional Part B enrollees. Those enrolled in Medicare Advantage plans were excluded.
The work was supported in part by a Small Research Grant from the American Academy of Physician Associates in 2022. The authors reported no relevant financial relationships.
At the same time the Medicare population is growing, the number of family practice (FP) physicians and the number of procedures they perform are decreasing, according to a new analysis in Annals of Family Medicine.
“The reasons might represent a changing scope of family practice, increasing referrals, shifting tasks to [physician assistants] and [nurse practitioners], or some combination,” wrote the authors, led by Robert McKenna, DMSc, MPH, PA-C, with Marshall B. Ketchum University, Fullerton, California. But understanding the reasons may be important to improve training programs.
The Council of Academic Family Medicine (CAFM) in 2014 addressed variability in how FPs perform procedures with a consensus statement on 44 procedures FPs should be competent to perform after a family medicine residency and 24 more for which residency programs should offer training.
Researchers wanted to see how often the procedures were being done so they performed a retrospective, observational study of the Medicare Part B cohort to understand how often FPs report CAFM-recommended procedures in an outpatient setting. They used data from 2014 to 2021, the most recent years for which data were available, and modified the list of procedures for Medicare beneficiaries to match with Current Procedural Terminology codes.
Procedures Dropped by a Third in 8 Years
For the 8 years ending in 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs who filed them, according to the paper. However, the number of FPs who treat Medicare beneficiaries has remained relatively stable. Almost all procedures performed were for the skin; musculoskeletal; eyes, ears, nose, and throat; and pulmonary categories.
There was a 17% decrease in every category of modified CAFM procedures between 2014 and 2019 before the pandemic.
Concurrently, the U.S. Bureau of Labor Statistics reported a 7% decrease in clinically active FPs from 2013 to 2022; 100,940 FPs were employed clinically in 2022. The Association of American Medical Colleges estimates a shortage of 17,800-48,000 primary care physicians by 2034.
“In 2021, the number of Medicare Part B claims by FPs for all [modified] CAFM outpatient procedures was reported by 12% of these clinicians and represented less than 1% of all CPT claims submitted,” the researchers wrote.
“Meanwhile, the 17% of Americans aged [at least] 65 years is projected to represent 20% of the U.S. population by 2030,” the authors pointed out.
The reasons for the decrease in procedures need further study, the authors said. From 2010 to 2020, there was a 30% and 47% increase in the employment of PAs and NPs, respectively, across all specialties, many employed in primary care. And 42% and 56% of family physicians reported working with PAs and NPs, respectively, from 2014 to 2018, according to the paper.
One explanation is a shifting of roles. “NPs and PAs might increasingly serve as proceduralists, freeing FPs to focus on other aspects of their practice such as complex chronic disease management or annual wellness visits,” the authors wrote.
It’s also possible that more Medicare-eligible Americans are being referred to various specialists such as urologists, gynecologists, and cardiologists, they speculated, adding that, “because demographic trends show an increasingly older population, family medicine training programs might need to adjust to meet this change.”
Among the limitations of the data are that publicly available Medicare data are limited to the approximately 60% of beneficiaries who are traditional Part B enrollees. Those enrolled in Medicare Advantage plans were excluded.
The work was supported in part by a Small Research Grant from the American Academy of Physician Associates in 2022. The authors reported no relevant financial relationships.
FROM ANNALS OF FAMILY MEDICINE