Annals of Family Medicine: New Studies Reveal Primary Care Access Gaps and a Shift Away From Broad Comprehensive Practice
PROVIDENCE, R.I., May 29, 2025 /PRNewswire/ -- Two new studies in Annals of Family Medicine examine the primary care workforce. One reveals that Ontario family physicians are shifting away from broad, comprehensive practice toward more focused roles. The other study finds that Virginia neighborhoods with higher proportions of Black residents have significantly more primary care physician (PCP) access, whereas rural communities have significantly less PCP access. Both studies carry important implications for patient access to care.
Researchers linked multiple Ontario health‑administrative data sets to track practice patterns for every general practitioner or family physician from fiscal years 1993/94 through 2021/22. A physician was classified as providing comprehensive care if, in a given year, they worked at least 44 billed days, devoted more than 50% of billings to core primary care services, and met the threshold for diversity of primary care activity areas. Physicians who did not meet all three criteria were grouped as follows: focused practice (for example, hospitalist work or emergency medicine); low volume, with fewer than 44 billed days; other primary care roles; a fourth group had no billings for the year.
Key findings:
- Although the overall supply of family physicians climbed from 104 to 118 per 100,000 residents during the study period, the supply offering comprehensive care fell from 71 to 64 per 100,000.
- Of the additional 6,310 family physicians who entered the workforce during the study period, 39.5% were in focused practice.
- Emergency medicine accounted for 37% of focused doctors in 2021/22, followed by hospitalist care at 26.5% and addiction medicine at 8.3%.
Neighborhood Determinants of Primary Care Access in Virginia
Researchers used the 2019 Virginia All-Payers Claims Database to identify primary care physicians (PCPs) and the number of patients seen by each physician. They then measured how many PCPs each census tract could reach within a 30‑minute drive, flagging tracts with too few as having poor access. Associations between PCP access and predisposing (age, race), enabling (income, insurance), need and structural (rurality, segregation) factors were assessed.
Key findings:
- Nearly half (44%) of Virginia's census tracts lacked adequate access.
- Racial segregation and rurality had the greatest associations with PCP access: tracts with higher proportions of Black residents had significantly greater PCP access than those with higher proportions of white residents, while rural tracts had significantly less access.
"Primary care continues to be a critical element for ensuring community health and health equity in Virginia, and this work illuminates the characteristics most associated with inadequate workforce," the authors conclude.
An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Hannah Shadowen, PhD, and Alexander Krist, MD, MPH, is available here.
Articles Cited:
Hina Ansari, PhD, MSc; Richard H. Glazier, MD, MPH; Susan E. Schultz, MSc; Michael E. Green, MD, MPH; Kamila Premji, MD, PhD; Eliot Frymire, MA; Maryam Daneshvarfard, MScCH; Liisa Jaakkimainen, MD, MSc; Tara Kiran, MD, MSc
Neighborhood Determinants of Primary Care Access in Virginia
Hannah M. Shadowen, PhD; Jennifer L. Gilbert, PsyD; Benjamin Webel; Adam Funk; Jong Hyung Lee, PhD; Scott M. Strayer, MD, MPH; Roy T. Sabo, PhD; Lauryn S. Walker, PhD; Michael Topmiller, PhD; Andrew Mitchell, PhD; Jacqueline B. Britz, MD, MSPH; Andrew J. Barnes, PhD; Alex H. Krist, MD, MPH
Annals of Family Medicine is an open access, peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals of Family Medicine is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals of Family Medicine is published online six times each year, charges no fee for publication, and contains original research from the clinical, biomedical, social, and health services areas, as well as contributions on methodology and theory, selected reviews, essays, and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed for free on the journal's website, www.AnnFamMed.org.
SOURCE Annals of Family Medicine
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