“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen.”Sen. Bernie Sanders (I-Vt.), in a July 19 press release
Sen. Bernie Sanders (I-Vt.) has long been a champion of a government-sponsored “Medicare for All” health program to solve long-standing problems in the United States, where we pay much more for health care than people in other countries but are often sicker and have a shorter average life expectancy.
Still, he realizes his passion project has little chance in today’s political environment. “We are far from a majority in the Senate. We have no Republican support … and I’m not sure that I could get half of the Democrats on that bill,” Sanders said in recent remarks to community health advocates.
He has switched his focus to include, among other things, expanding the primary care workforce.
Sanders introduced legislation in July that would invest $100 billion over five years to expand community health centers and provide training for primary care doctors, nurses, dentists, and other health professionals.
“Tens of millions of Americans live in communities where they cannot find a doctor while others have to wait months to be seen,” he said in a press statement issued when the bill was introduced. He noted that this scenario not only leads to more human suffering and unnecessary deaths “but wastes tens of billions a year” because people who “could not access the primary care they need” often end up in emergency rooms and hospitals.
Is that true? Are there really tens of millions of Americans who can’t find a doctor? We decided to check it out.
Our first stop was the senator’s office to ask for the source of that statement. But no one answered our query.
Primary care, by the Numbers
So we poked around on our own. For years, academic researchers and policy experts have debated and dissected the issues surrounding the potential scarcity of primary care in the United States. “Primary care desert” and “primary care health professional shortage area” are terms used to evaluate the extent of the problem through data — some of which offers an incomplete impression. Across the board, however, the numbers do suggest that this is an issue for many Americans.
The Association of American Medical Colleges projects a shortage of up to 48,000 primary care physicians by 2034, depending on variables like retirements and the number of new physicians entering the workforce.
How does that translate to people’s ability to find a doctor? The federal government’s Health Resources and Services Administration publishes widely referenced data that compares the number of primary care physicians in an area to its population. For primary care, if the population-to-provider ratio is generally at least 3,500 to 1, it’s considered a “health professional shortage area.”
Based on that measure, 100 million people in the United States live in a geographic area, are part of a targeted population, or are served by a health care facility where there is a shortage of primary care providers. If they all want doctors and cannot find them, that figure would be well within Sanders’ “tens of millions” claim.
The metric is a meaningful way to measure the impact of primary care, experts said. In those areas, “you see life expectancies of up to a year less than in other areas,” said Russ Phillips, a physician who is director of Harvard Medical School’s Center for Primary Care. “The differences are critically important.”
Another way to think about primary care shortages is to evaluate the extent to which people report having a usual source of care, meaning a clinic or doctor’s office where they would go if they were sick or needed health care advice. By that measure, 27% of adults said they do not have such a location or person to rely on, or that they used the emergency room for that purpose in 2020, according to a primary care score card published by the Milbank Memorial Fund and the Physicians Foundation, which publish research on health care providers and the health care system.
The figure was notably lower in 2010 at nearly 24%, said Christopher Koller, president of the Milbank Memorial Fund. “And it’s happening when insurance is increasing, at the time of the Affordable Care Act.”
The U.S. had anadult population of roughly 258 million in 2020. Twenty-seven percent of 258 million reveals that about 70 million adults didn’t have a usual source of care that year, a figure well within Sanders’ estimate.
Does everyone want this relationship?
Still, it doesn’t necessarily follow that all those people want or need a primary care provider, some experts say.
“Men in their 20s, if they get their weight and blood pressure checked and get screened for sexually transmitted infections and behavioral risk factors, they don’t need to see a regular clinician unless things arise,” said Mark Fendrick, an internal medicine physician who is director of the University of Michigan Center for Value-Based Insurance Design.
Not everyone agrees that young men don’t need a usual source of care. But removing men in their 20s from the tally reduces the number by about 23 million people. That leaves 47 million without a usual source of care, still within Sanders’ broad “tens of millions” claim.
In his comments, Sanders refers specifically to Americans being unable to find a doctor, but many people see other types of medical professionals for primary care, such as nurse practitioners and physician assistants.
Seventy percent of nurse practitioners focus on primary care, for example, according to the American Association of Nurse Practitioners. To the extent that these types of health professionals absorb some of the demand for primary care physician services, there will be fewer people who can’t find a primary care provider, and that may put a dent in Sanders’ figures.
Finally, there’s the question of wait times. Sanders claims that people must wait months before they can get an appointment. A survey by physician staffing company Merritt Hawkins found that it took an average of 20.6 days to get an appointment for a physical with a family physician in 2022. But that figure was 30% lower than the 29.3-day wait in 2017. Geography can make a big difference, however. In 2022, people waited an average of 44 days in Portland, Oregon, compared with eight days in Washington, D.C.
Our ruling
Sanders’ claim that there are “tens of millions” of people who live in communities where they can’t find a doctor aligns with the published data we reviewed. The federal government estimates that 100 million people live in areas where there is a shortage of primary care providers. Another study found that some 70 million adults reported they don’t have a usual source of care or use the emergency department when they need medical care.
At the same time, several factors can affect people’s primary care experience. Some may not want or need to have a primary care physician; others may be seen by non-physician primary care providers.
Finally, on the question of wait times, the available data does not support Sanders’ claim that people must wait for months to be seen by a primary care provider. There was wide variation depending on where people lived, however.
Overall, Sanders accurately described the difficulty that tens of millions of people likely face in finding a primary care doctor.
We rate it Mostly True.
Sources
Sen. Bernie Sanders, “NEWS: In Remarks to Advocates, Sanders Proposes Major Expansion of Community Health Centers,” Feb. 8, 2023.
Sen. Bernie Sanders, “NEWS: Chairman Sanders Introduces Major Legislation on Primary Care and Announces HELP Markup Next Week,” July 19, 2023.
Senate bill, “To improve access to and the quality of primary health care, expand the health workforce, and for other purposes,” accessed July 21, 2023.
Association of American Medical Colleges, “AAMC Report Reinforces Mounting Physician Shortage,” June 11, 2021.
Health Resources and Services Administration, “What Is Shortage Designation?” June 2023.
Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed July 24, 2023.
Health Resources and Services Administration, “Designation of Health Professional(s) Shortage Areas,” accessed July 26, 2023.
KFF, “Primary Care Health Professional Shortage Areas (HPSAs),” Sept. 30, 2022.
The Milbank Memorial Fund and the Physicians Foundation, “The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care,” Feb. 21, 2023.
The Milbank Memorial Fund, “The Effectiveness of Policies to Improve Primary Care Access for Underserved Populations: An Assessment of the Literature,” Jan. 24, 2022.
American Association of Nurse Practitioners, “NP Fact Sheet,” November 2022.
Meritt Hawkins, “Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates,” 2022.
Interview with Mark Fendrick, physician and director of the University of Michigan Center for Value-Based Insurance Design, July 21, 2023.
Interview with Christopher Koller, president of the Milbank Memorial Fund, July 21, 2023.
Interview with Jacquelyn Resnik, Teladoc Health, July 21, 2023.
Interview with Russ Phillips, physician and director of Harvard Medical School Center for Primary Care, July 24, 2023.
Interview with Michael Dill, director of workforce studies at the Association of American Medical Colleges, July 24, 2023.
Email interview with Martin Kramer, director of communications at Health Resources and Services Administration, July 25, 2023.
Email interview with Jewel Jordan, public affairs specialist, U.S. Census Bureau, July 26, 2023.
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