Primary care scarcity linked to more surgical emergencies & problems

March 21, 2024
Worse outcomes for patients living in rural and urban areas with few primary care providers suggests need to boost efforts to increase training and geographic distribution.

America’s shortage of primary care doctors and nurse practitioners has a downstream effect in the nation’s operating rooms, a new study finds. 

And patients suffer as a result. 

In all, people living in areas with the most severe shortages of primary care providers have a much higher risk of having emergency surgery, rather than a scheduled operation, compared with people with the same condition who live in areas with less-dire primary care shortages. Those living in the areas with the lowest availability of primary care providers also have a higher chance of suffering complications after surgery, and needing to go back to the hospital after they’ve left it, according to the findings in the journal Health Affairs from a team at Michigan Medicine, the University of Michigan’s academic medical center. 

The team looked at data for people with traditional Medicare coverage who had operations for conditions where timing can really matter: colectomy to remove a cancerous area of the colon, repair of a hernia, and repair of aneurysms in wall of the aorta, the body’s largest blood vessel. 

They focused only on people living in areas classified by the federal government as having a shortage of primary care providers. They then divided these areas into five levels of shortage. 

In all, nearly 38% of the patients living in the more-severe shortage areas had their operations on an emergency basis, compared with 30% of those living in the areas with the least-severe shortages. 

Those living in areas with more severe shortages also had a higher risk of serious complications from surgery (15% vs. nearly 12%), and those living in the most severe shortage areas also had a higher risk of readmission to the hospital (nearly 16% vs. 13.5%). 

The study did not show a difference in patients’ risk of death based on severity of primary care shortage, they did show that mortality risk was lower for those living in non-shortage areas compared with shortage areas. 

The results of the study, the authors say, should underscore the importance of efforts to increase the supply of primary care providers and to attract them to practice in underserved areas. 

This includes both rural and urban primary care shortage areas; the study found that 58% of the census tracts classified as having a primary care shortage of any level were rural. 

Michigan Medicine release