Q&A: Identifying, Addressing Gaps in Primary Care

The US health care system is facing a primary care physician shortage that is expected to reach 50,000 by the end of 2025. Compounded with an aging population in need of life-saving medications, as well as an increased prevalence of chronic conditions, health care experts are urging providers to play their role in addressing this gap.

“There are just fewer people that go into primary care, and [there are] challenges that arise because of that. There's been some positive signs with physician assistants, with nurse practitioners that are entering that area to shore up the primary care gap. But at the same time, while right now that looks fairly robust, there is still the concern that [it] also is going to start ticking towards specialty care, and we're going to wind up in the same place if we don't take a really close, hard, clear-eyed look at primary care as something we need to really focus on,” said Jonathan Watanabe, PharmD, MS, PhD, BCGP, co-author of the 2025 Pharmacy Forecast.

Despite some positive signs from nurse practitioners and physician assistants, there is still a noticeable gap in primary care. | image credit: charli / stock.adobe.com

Watanabe co-authored a section titled “Addressing the Gap in Primary Care” from the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast—an annual report detailing opportunities and challenges pharmacy leaders may face in their profession in the near future. He sat down with Drug Topics to discuss the factors leading to primary care gaps and what possible federal interventions industry leaders can be on the lookout for.

READ MORE: Q&A: The Importance of ASHP’s 2025 Pharmacy Forecast

Stay tuned for more Drug Topics interviews regarding the ASHP 2025 Pharmacy Forecast. As we meet with authors and industry leaders that contributed to the report, we will discuss some of its main sections.

Drug Topics: The pharmacy forecast owes the gap in primary care to an expanding shortage of primary care providers, an aging society, and an increased prevalence of chronic conditions. Are there other noticeable gaps in primary care, or are these the key factors that health systems are looking to tackle?

I think you've covered most of them. I know that what we describe in the data, in terms of the impetus, is that 75 million people in the United States live in primary care health workforce shortage areas. The estimate of primary care physician shortage is expected to reach nearly 50,000 by this year. Every metric we see is that we've got an identifiable shortage of primary care access, particularly for physicians, and that's unexpected to continue. A lot of it is due to the reasons you mentioned: rapidly aging population that utilize more medications. Most people over 65 have 2 or more disease states, are on multiple medications. So those, in itself, with more than 12,000 older adults that turn 65 plus each day in the United States, we just have this exponential growth. We know that there's those key components, fewer primary care providers, the rapidly aging population, increased use of medications. A lot of these things are actually because we have advances in terms of the increase in medications.

But on top of that, to your question, I think there are other factors. It's that low reimbursement for primary care activities that I think we're going to really have to grapple with. There are just fewer people that go into primary care, and the challenges that arise because of that. There's been some positive signs with physician assistants, with nurse practitioners that are entering that area to shore up the primary care gap. But at the same time, while right now that looks fairly robust, there is still the concern that that also is going to start ticking towards specialty care, and we're going to wind up in the same place if we don't take a really close, hard, clear-eyed look at primary care as something we need to really focus on. I think that's a segue to the rest of our discussion; that’s a great place for pharmacists to have an increasing role, almost sadly. I think to some ways, they're going to have an increasing role whether we pharmacists choose it or not because more patients just go to their pharmacist, go to their pharmacy, as a place that I almost think is primary [to] primary care. They'll try to access their pharmacy, ask questions, get the vaccinations, testing when it's available. Many times, that's the option that they seek before they even reach out to their primary care provider. We witnessed that during the pandemic, and that's not going to be lost on society forever. That's informing more federal health policy. I think that these are the things that really resonate [and won’t] subside, at least anywhere in the near-term future with the way population level projections are heading.

Drug Topics: In many cases, when health care providers do not have the resources and tools to alleviate a nationwide issue, they look to the federal government to enact change. The report mentions federal efforts to address the gap in primary care and the government’s possible responses. Can you summarize what those responses might be and which you think may be enacted in the near future?

I think, based on the responses from the forecast itself, 60% [of forecast panelists] will declare a primary access crisis in the next 5 years. But whether there's going to be strong movement towards something specific, I think that was a lower percentage, if I remember correct. What could occur is calling it a primary care access crisis, which we've seen in other public health emergencies—opioid use disorder, pandemic. But I think the federal agencies have been nonspecific about what that's going to entail. I think it's been well stated. You can look on the websites and you can see that they're calling this an access issue. But, it's been very general about how that needs to be addressed. And I think that's because there is some level of uncertainty about what's going to be feasible, what's going to be palatable, what's going to be effective.

I think that simply making mandates hasn't been addressed yet, because I think that there probably materially is some concern about if it's going to be effective, if it's going to be feasible. Who are going to be the actors that are going to operationalize those things? I think those things are still undetermined. I certainly can't say exactly how that would manifest, and I think that's sort of what you're seeing. There’s a real acknowledgement that we have a crisis in terms of primary care access, which impacts so many things, including specialty. There's been studies that have shown that. How do we specifically develop mandates to address it? I think that still is TBD. But many systems, many settings, many regions, many states, they are taking action. What that group has also discussed is likely steps will be taken at the regional level, at the state level, if not federal. I think that [there is an] acknowledgement that it's an access crisis, but yet, we're not seeing necessarily federal interventions. That's not to say that things aren't going to be done. It just may be approached at something that's more provincial, if you will.

READ MORE: Health System Resource Center

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Reference

Pharmacy Forecast. American Society of Health-System Pharmacists Foundation. December 9, 2024. Accessed January 17, 2025. https://www.ashpfoundation.org/research/pharmacy-forecast