How are Primary Care Panel Sizes changing in the United States, and what are the implications for Physician wellness?

Problem

In an age of team-based, increasingly complex primary care(PC) in the U.S., there are gaps in our understanding of trends in physician panel size, optimal panel sizes and their relationship to physician well-being. It is important to fill this gap amidst increasing consolidation of primary care practices into large hospital and venture capital financed health systems which frequently create pressures to expand panels and add new patients. We used unique data from a national survey with 100% response rates to investigate trends in U.S. Family Physician panel sizes and the association between panel size and physician burnout.

Approach

To determine trends in panel size, we used self-reported data from practicing Family Physicians collected on the American Board of Family Medicine Continuing Certification Questionnaire between 2013 to 2022. The questionnaire is a mandatory component of exam registration, resulting in a 100% response rate and a partial annual census that captures all diplomates once every 10 years. Some 55,605 US-based Family Physicians completed the survey between 2013-2022 who reported providing ambulatory continuity care. We then pooled survey responses from 2,041 board-certified family physicians (FPs) between 2017 and 2021 who provided continuity patient care and were randomly selected to respond to a survey module that included burnout questions. We estimated the odds of burnout by panel size adjusting for physician age, gender, race, and their practice characteristics including practice organization, rurality, percentage of vulnerable patients, team composition, and hours spent on direct patient care and administrative tasks.

Findings

Between 2013-2022, self-reported mean panel size among U.S. Family Physicians decreased by 25%, from a high of 2,362 in 2013 to a low of 1,760 in 2021. Despite variations across practice organizational types, larger panel sizes were consistently associated with higher risks of burnout, specifically emotional exhaustion and callousness towards patients. Physicians with larger panels had significantly increased odds of experiencing burnout symptoms, even after adjusting for relevant covariates. Notably, deviance in panel size estimates was not linked to the likelihood of burnout, ruling out potential biases in reporting practices.

Consequences

Monitoring and addressing optimal PC patient panel size is crucial amidst national workforce shortages and rising PC physician burnout. National workforce planners must account for decreasing panel size trends in their projections. Hospitals and health systems must reduce pressures to expand PC panels and advance interventions aimed at optimizing panel sizes, such as implementing robust PC teams. Finally, investments in increasing PCP supply are essential to ensure equitable access to high-quality primary care, aligning with national goals outlined by in the U.S. National Academy of Medicine recent landmark report on high-performing primary care.