Office visits to primary care physicians declined by 18 percent between 2012 and 2016, according to a recent study by the Health Care Cost Institute. The HCCI analysts limited their observations to adults younger than age 65 with employer-sponsored health insurance. When other patients were included, “they noted a 2 percent decrease in all PCP office visits from 2012 to 2016” (medscape.com). The question is “Why?”
First of all, fewer office visits to primary care physicians reflects the movement toward a more team-based approach to care, shifting more patient care responsibilities to nurse practitioners and physician assistants, says Michael Good, M.D., of ProHealth Physicians in Middletown, Connecticut. This allows the physicians to focus on managing “a complex sick group [of patients] with multi-organ problems,” adds Dr. Good, “while the mid-levels [NPs and PAs] see more pediatric and younger adult patients who tend to have single-system problems” (medpagetoday.com).
The HCCI report notes that “[h]aving more NPs and PAs provide primary care may ease the potential shortages” of primary care physicians. Although some experts also assume that use of more mid-level practitioners will bring down the costs of heath care, the report does not support this assumption: Since 2012, “the average cost of an office visit to a PCP remains closely aligned with the cost of an NP and PA visit. In 2016, the average cost per visit to a PCP was $106 compared with $103 for an office visit to an NP or PA” (medscape.com).
While office visits to primary care physicians were falling, visits to urgent care clinics increased by 119 percent among insured Americans between 2008 and 2015 (JAMA Internal Medicine). “Lying somewhere on the continuum between primary care and the emergency department, urgent care has become the predominant choice for many healthcare consumers, especially for busy working families and millennials” (medicalbag.com). According to the Urgent Care Association of America, there are approximately 7100 urgent care centers in the U.S. today with a market expected to reach $30.5 billion by 2020, up from $23.5 billion in 2013.
The drop in primary care office visits, coupled with the growth of urgent care clinics, is being driven in large part by millennials. Born in the early-1980s to mid-1990s, millennials make up 25 percent of the total U.S. population. “They want healthcare to be more convenient and do not want to miss work for a medical appointment. Instead, they would rather go to urgent care to get the services they need because it is quicker and easier to be seen–even if there’s a queue. Statistically speaking, millennials are likely at the peak of their health and don’t need frequent appointments to manage several chronic conditions or medications” (physicians practice.com).
In one recent survey, 32 percent of the millennials said they would use whichever health system provided the timeliest access to its services, compared with 19 percent of Generation Xers and 19 percent of Baby Boomers (healthcarecommunication.com). Taking note, some primary care practices now have extended their office hours and offer their patients “same day” or “next day” appointments.