Primary Care Provider Turnover and Patient Outcomes By Practice Size

Background: Over 75% of physicians experience burnout and 30% of primary care providers (PCPs) are over 60 years of age and are nearing retirement. The resultant loss of a PCP could disrupt patient care, the effects of which are unclear.

Methods: Using a sample of PCPs and their Medicare patients from 2008-2016, PCPs who stopped practicing were matched to PCPs who remained in practice. Difference-in-differences analyses compared use of primary, specialty, emergency department (ED), urgent, and inpatient care as well as the probability of death and spending for patients who did and did not lose PCPs, with subgroup analyses by practice size.

Results: On average, 8% of PCPs were found to exit Medicare. 268,883 Medicare patients whose PCP exited (n=9,142 PCPs) were compared to a similar group of 282,436 Medicare patients whose PCP did not exit (n=9,142 matched PCPs). In the two years after a PCP left practice, affected patients had 13.8% fewer primary care visits (P<0.001), 5.3% more specialty care visits (P<0.001), and 9.9% more urgent care visits (P<0.001) per year, as compared to patients who did not lose a PCP. Patients who lost a PCP also had 3.5% more ED visits (P<0.001), 2.0% more inpatient visits (P=0.02), and spending increased $208.78 (P=0.008) the first year post-exit. Solo practice patients were the most affected.

Conclusions: A PCP’s exit from Medicare was associated with decreased use of primary care, increased use of specialty, ED, urgent, and inpatient care as well as spending. The largest effects were among solo practice patients.