Renewed by implementation of the federal Affordable Care Act and the state’s Medicaid expansion, experts continue to warn about existing and impending primary care physician shortages statewide and nationally. Should Michigan be worried? It turns out that our statewide supply of primary care physicians is better than average, but when the Citizens Research Council dug deeper, we found that many Michigan counties have insufficient numbers of primary care physicians including family doctors, internists, pediatricians, obstetricians and gynecologists, general surgeons, and especially psychiatrists.
The Detroit Metro region, which includes Macomb, Oakland, and Wayne counties, has a high number of primary care physicians relative to the population, especially compared to other parts of the state. However, within the region, the supply of primary care physicians varies widely.
CRC examined shortages using two methods. First, we looked at the U.S. Department of Health and Human Services’ Health Resources and Services Administration designated primary care shortage areas. These exist where the number of physicians relative to the population is lower than a standard ratio or, alternatively, based on demonstrated need such as economic or cultural barriers. Additionally, a particular facility may be given a shortage designation if they care primarily for an underserved population. By this measure, these three counties had a total of 20 federally designated shortage areas. While 16 of these were in Wayne County, 13 were in the City of Detroit.
In fact, Wayne County has the most federally designated shortage areas in the state and the City of Detroit has more federally designated shortage areas than any county other than Wayne. Most federal shortage designations in Detroit are for facilities that treat high need populations, such as those with especially high infant mortality rates or with more than 20 percent of the population living below the poverty line. Some areas of Detroit are worse off than others: Map 1 (attached) shows the census tracts that comprise the federally designated Brightmoor Service Area on the west side of Detroit. Within these census tracts only 1 primary care physician serves 41,168 residents and the population has a poverty rate of nearly 31 percent. Federal standards for a region with this poverty rate alone would be a primary care physician-to-population ratio of 1 to 3,000.
Inkster is another Wayne County city that has an insufficient number of primary care physicians relative to its population. Metro area facilities that are federally designated shortage areas because they serve high need populations are found in Mount Clemens, Pontiac, and Westland. New Haven hosts a correctional facility that is federally designated as a shortage area and within Dearborn there is a Native American Tribal population that is automatically given a federal shortage designation.
CRC also examined shortages by looking at the actual ratio of physicians relative to the population for each county and compared this to research-based suggested physician-to-population ratios. Using this criterion, counties in the Detroit Metro region fared better than those outstate. On a county-wide basis, Oakland and Wayne counties had a sufficient number of physicians that specialize in family and general medicine, internal medicine, pediatrics, general surgery, obstetrics and gynecology, and psychiatry. Macomb County had an insufficient number of psychiatrists, but the supply of the other physicians analyzed was at least sufficient.
The main issue that arises from county-wide shortages is access to proper and continuous health care, especially for high need or at-risk populations. From these two shortage metrics, we know that although Wayne County has a sufficient number of primary care providers on a county-wide basis, they are not strategically located in the places that serve the needs of all county residents. Limited transportation options in Detroit and across the county further limit access to already existing practices and hospitals. These shortages may also mean that residents that are uninsured, insured through Medicaid, live in poverty, or have high medical needs and for these reasons are turned away from some providers. These federally designated facilities are often the only ones that will treat them.
Primary care is an integral part of an affordable and effective healthcare system. CRC’s new report, Where are the Primary Care Doctors?, examines shortage data across Michigan, looks at the causes for primary care physician shortages, and provides options for policymakers to both increase the supply of primary care physicians and alleviate service demand placed on these providers. The future of our public’s health relies on primary care services, provided from a variety of provider types, and needs the support of policymakers and citizens alike to reinstate a sense of value.