A robust and stable primary care workforce is required to ensure access to high-quality primary care across communities in the United States, as recommended by the National Academies of Sciences, Engineering, and Medicine (NASEM).17 Unfortunately, the country continues to face a concerning shortage of primary care physicians and poor distribution of primary care clinicians—including physicians, nurse practitioners (NPs), and physician assistants (PAs). The proportion of healthcare trainees who choose to focus on primary care has decreased in recent years, and primary care training now disproportionally takes place in hospitals rather than in the community settings where primary care services mainly occur.17,28 In fact, the U.S. primary care physician workforce is shrinking, with a projected shortage unable to meet patient demand by 2035.17,29 In addition, there are growing gaps in access to care in medically underserved communities—such as rural areas—due to wide variation in where primary care clinicians are located.17
Although it has eased since the COVID-19 public health emergency, the primary care workforce continues to face concerningly high rates of burnout.30,31 In addition to the personal toll on physicians and their families, burnout has been found to lead to poorer quality of care, lower patient satisfaction, and decreased patient safety.32–34 Poor physician well-being, low professional satisfaction, and high burnout leads some clinicians to reduce their hours or leave practice altogether, further exacerbating workforce shortages.33
Ongoing research is needed to better understand how to measure, expand, and strengthen the primary care workforce, mitigate clinician burnout, leverage innovative technologies to reduce burden, and examine how to best support primary care clinicians in communities throughout the United States. Studies that measure, track, and contribute to understanding the experience of the primary care workforce are necessary to ensure access to quality primary care. Ƶhas identified primary care workforce as a topic area of interest, although investments in 2023 and 2024 were limited to a small number of grants, as described in this section.
Grants
Across AHRQ primary care research grants with active funding in FYs 2023 and 2024, six focus mainly on primary care workforce. This includes three R03 grants (Small Research Projects), one R01 grant (Research Project), one R36 award (Dissertation Grant), and one K08 grant (Mentored Clinical Scientist Development Award).
An additional 10 grants include some focus on primary care workforce and are described in other topic area sections, including four in Healthcare Systems and Infrastructure, two in Behavioral Health and Substance Use Disorders, one in Digital Healthcare, one in Healthcare Disparities, one in Patient Safety and one in Practice and Quality Improvement.
We summarize the six grants focused on primary care workforce below, organized by subtopic. The subtopics are:
Clinician and Staff Burnout
Three studies examine how to identify and address burnout and burden in the primary care workforce.
(K08)
PI: Daniel Tawfik
Organization: Stanford University
Grant Start Date: September 30, 2020
Develops and validates a tool to identify the primary care practices at greatest risk for clinician burnout. The tool uses an algorithm that collates EHR data, metadata, and progress notes to produce predicted practice burnout scores to facilitate the prevention of burnout before it occurs.
Learn more about this study in the NCEPCR Impact Story: Enabling Real-Time Identification of Burnout Risk Among Clinicians in Primary Care Practices (PDF, 545 KB).
(R03)
PI: Natalie Virginia Schwatka
Organization: University of Colorado – Denver
Grant Start Date: September 1, 2024
Evaluates the safety, health, and well-being needs of the workforce at federally qualified health centers (FQHCs), with the goal of reducing burnout and improving retention. Aims to determine how FQHCs can use leadership practices to improve the working environment at FQHCs for existing and future staff. Assesses the relationship between FQHC primary care workforce well-being and turnover.
(R01)
PI: James C Benneyan
Organization: Northeastern University
Grant Start Date: September 30, 2024
Uses systems science and systems engineering approaches to better understand and address the impacts of growing asynchronous care demands (e.g., patient portals, EHR email, and text messaging) on clinician burnout. Uses analytic process simulation and system dynamics models to better understand the issues and system resiliency analysis and design methods to suggest more robust adaptive processes.
The Role of the NP in Primary Care
Two studies focus on the role of the NP in the primary care workforce.
(R36)
PI: Amy L McMenamin
Organization: Columbia University Health Sciences
Grant Start Date: June 1, 2023
Assesses care environments for NPs to understand how primary care practices can support NPs providing complex care for people with multiple chronic conditions (MCCs), particularly in communities with low socioeconomic resources. Investigates the relationship between NP care environments (e.g., level of support for NP practice, collegiality between clinicians, and an organizational understanding of the NP role), community characteristics (i.e., socioeconomic resources and availability of primary care), and acute care utilization among older adults with MCCs.
(R03)
PI: Hannah Toby Neprash
Organization: University of Minnesota
Grant Start Date: April 1, 2022
Develops a national database of all-payer claims and EHR data to examine how much adding NPs to primary care teams increases access to care, particularly for patient populations that have traditionally faced barriers to access.
Learn more about this study in a recent NCEPCR webinar: Research Methods for Studying the Primary are Workforce
Using AI for Documentation
One study looks at the value of AI for reducing burden to support the primary care workforce.
(R03)
PI: Joshua Biro
Organization: Medstar Health Research Institute
Grant Start Date: September 30, 2024
Aims to develop a prototype guide for the safe and effective use of AI documentation technologies, known as Ambient Digital Scribes (ADSs), in primary care. ADSs have the potential to reduce documentation burden for clinicians—a leading cause of burnout. This study uses retrospective data analyses and interviews with primary care clinicians and patients to understand the barriers and facilitators to successful ADS use and build foundational knowledge about how ADSs can be successfully integrated into the primary care workflow. With input from a range of key actors, this study aims to develop a prototype guide designed to support ADS implementation and use at healthcare organizations of all sizes and types, including rural primary care clinics and FQHCs.
Initiatives and Resources
Ƶreleased the following resources related to the primary care workforce in FYs 2023 and 2024.
A Pragmatic Approach to Identifying and Profiling Primary Care Clinicians and Primary Care Practices in the USA
“A Pragmatic Approach to Identifying and Profiling Primary Care Clinicians and Primary Care Practices in the USA” in the Journal of General Internal Medicine, was written by current and past Ƶstaff. Using the IQVIA OneKey Healthcare Professional database, the framework described in this article prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations and then identifying primary care practices based on organizational types and presence of primary care clinicians.
Burnout in Primary Care: Assessing and Addressing It in Your Practice
This resource (PDF, 1.6 MB) is focused what can be done to address clinician and staff burnout in primary care at an organizational or practice level. The resource includes tools and guidance that primary care administrators, leaders, and clinicians can use to address burnout within their organization, including validated assessment tools to measure burnout within an organization and identify its root causes, and steps individual organizations can take to tackle burnout based on their unique organizational needs.
NCEPCR Webinar: Research Methods for Studying the Primary Care Workforce
NCEPCR hosted a webinar on research about the primary care workforce in May 2024. In the webinar, three Ƶgrantees presented methods and findings from their research about the optimal structure and composition of primary care teams and measuring the impacts of adding nurse practitioners into primary care.
In an Ƶprimary care research grant led by PI Daniel Tawfik, researchers have developed a prediction tool to identify primary care practices at high risk of clinician burnout. Instead of relying on clinician surveys that increase burden, the tool enables real-time reports using already collected EHR data to help predict and prevent burnout before it occurs. Practices identified as high-risk can implement tailored process improvements to avoid the negative impacts of burnout on clinician well-being and patient care and safety.
To learn more about this study and how you can access this burnout prediction tool read the NCEPCR Impact Story: Enabling Real-Time Identification of Burnout Risk Among Clinicians in Primary Care Practices (PDF, 545 KB).
