Concerns over physician shortages in the nation and state have been brewing for decades. Between expanded health coverage, an aging population, a changing medical workforce, and a multitude of other factors, primary care physician shortages continue to be a growing concern. Should Michigan be worried? Are all communities affected equally? Statewide, the number of active physicians relative to the population is above the national average but further analysis shows that physicians are more concentrated in certain areas of the state while shortages exist in other regions.
The West Michigan Region includes Allegan, Barry, Ionia, Kent, Lake, Mason, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Osceola, and Ottawa counties. CRC examined shortages in this region using two methods. First, CRC looked at the U.S. Department of Health and Human Services’ Health Resources and Services Administration’s 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.
Using these criteria, Montcalm was tied with Chippewa County for having the second most federally designated shortage areas in the state-11, while Ionia County had 9. Both Montcalm and Ionia have a high number of rural health clinics ascribed with this federal designation, but Montcalm also has a large low-income population, countywide, affording the entire county a federal shortage designation.
CRC also examined shortages across the state 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, Lake County was one of four counties statewide that had physician-to-population shortages below suggested ratios for each of the primary care fields CRC examined: general and family medicine, internal medicine, pediatrics, general surgery, obstetrics and gynecology, and psychiatry.
For the West Michigan region, shortages of internal medicine physicians existed in half of the counties. While 5 of the 13 counties in the region also had shortages of pediatricians, the share of the populations in Ionia, Montcalm, Oceana, and Osceola counties aged 0-19 are equal to or greater than the statewide average indicating that these shortages may be even more severe. Finally, as with 70 percent of the counties across the state, most of the counties in the West Michigan region had insufficient numbers of psychiatrists relative to the population. Only physician-to-population ratios in Kent, Mason, and Muskegon counties fell within the ideal range. In fact, Kent, Mason, and Muskegon counties had physician-to-population ratios that fell within or above ideal ranges for all the primary care fields CRC examined.
Repercussions of primary care physician shortages may include long wait times to see doctors, long drive times between home and medical care, and disjointed medical treatment, all of which may lead to higher mortality rates and lower overall population health.
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 some of the 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.