The Supply, Demand Out-of-Equilibrium for Primary Care Behavioral Health in US Cities

Supply and demand are out of balance for primary care physicians (PCPs) and behavioral health providers (BHPs) in the United States, according to a new report that analyzes trends in urban areas.

Meanwhile, at least one forecast predicts that the nation needs more of both to avoid a physician shortage in the coming years.

But it’s also clear that cities in growth states have fewer PCPs and BHPs right now, while other parts of the country with slower growth rates have more doctors in their population.

Those findings were part of a new report by market consultant Trilliant Health, which uses data from the U.S. Census Bureau to describe the disparities between population hotspots and the locations of health care providers.

“Quantifying the current state of provider delivery at the local level is necessary to understand current and future gaps in the delivery of both primary care and behavioral health services,” said Dr. Sanjula Jain’s report , Trilliant Health’s principal investigator.

Facing a shortage

The Association of American Medical Colleges report, “The Complexity of Physician Supply and Demand: Projections from 2019 to 2034,” has become a cited source for the prediction that the United States may have a physician shortage of 37,800 to 124,000 by 2034 .

But the situation is not uniform across the nation.

“Understanding what is needed to ‘fix’ the provider shortage must begin with identifying which geographic areas have an oversupply or undersupply of providers by specialty,” Trilliant Health’s report said.

Seeking primary care

Based on census data, the average PCP rate per 100,000 people is 110 for the United States, in metropolitan areas with a population of at least 200,000. The report recognizes the contribution of health care workers such as physician assistants and nurse practitioners in primary care, but limits the number of staff to board-certified physicians.

Demand for primary care declined during the pandemic, “more a function of changes in patient behavior than a reduction in disease burden,” the report said. Demand for primary care is projected to grow by 1.4% per year until 2029 overall.

In the coming years, growth states like Idaho, Utah, Texas, Nevada, Arizona and Florida are projected to see at least a 1.9% increase in demand for primary care services through 2029, but these states have many cities with the most low ratio of PCPs per 100,000 people, the report said. Meanwhile, states such as Massachusetts, Wisconsin, Indiana and Ohio are projected to increase PCP demand the most at 1.2%, but have the highest concentration of PCP.

Behavioral health care

BHPs are less common, with a national average of 61 per 100,000 people, in metropolitan areas with at least 200,000 people, according to the Trilliant Health report. This figure includes psychiatrists, psychologists, behavioral therapists, social workers and psychiatric nurse practitioners.

As of June, 32.8% of adults reported symptoms of anxiety or depression, down from more than 40% during the peak of the COVID-19 pandemic.

Although this demand has waned, there is increasing attention on integrating behavioral health screening into primary care. The Trilliant Health report noted this month that the US Preventive Services Task Force issued its draft recommendations to support primary care screening for depression, anxiety and suicide risk in adults.

Those recommendations highlight “the potential for some mental and behavioral health conditions to go untreated or undiagnosed, in part because of the shortage of providers across the country,” the report said.

“Despite efforts to better integrate primary care and behavioral health care, how will the screened population be treated if adopted nationally, given the insufficient supply of BHPs?” the report said. He called for healthcare stakeholders to study consumer behavior and preferences at the hyperlocal level and for more analysis to compare PCP and BHP demand across markets.

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