Communities with more primary-care physicians have
lower mortality rates, according to an analysis by
researchers from the Johns Hopkins
Bloomberg School of Public
Health and New York University. The researchers also
found that having more specialty-care physicians in a
community did not have the same positive impact on health
and that increasing the number of specialists would not
improve the health status of the U.S. population when
compared to other industrialized countries.
The study was published as a Web exclusive on the
Health Affairs Web site March 15.
"Decisions about the physician supply should be made
on the basis of evidence for their utility in improving
health and reducing ill health and deaths. Currently, the
United States has many more specialists than do other
comparable countries with better health levels," said
Barbara Starfield, lead author of the study and a
University Distinguished Service Professor in the
Department of Health Policy and Management at the
Bloomberg School.
The study authors reviewed mortality data from 1996 to
2000 for 3,075 U.S. counties, which make up 99.9 percent of
all U.S. counties. The researchers found that having a
higher specialist-to-population ratio did not decrease
mortality rates. They also determined that too many
specialists would negatively impact communities because
more patients would be seen by specialists and would be
more likely to receive unnecessary tests and procedures.
The researchers report that in the United States the
boundaries between the roles of specialists and
primary-care physicians are blurred. In countries other
than the United States, specialists typically work in
hospitals and see patients only on referral from
primary-care physicians, so that the roles are clearly
delineated.
In the United States, however, specialists may treat
patients for ailments outside their area of expertise, thus
putting patients at a higher risk of death. In addition,
more specialists decrease the number of procedures
performed per physician, which further increases risks of
complications or mortality.
"Having too many physicians leads to unnecessary care
and runs the risk of greater adverse effects. Simply
training more specialists is unlikely to improve health and
will greatly increase costs. The challenge for the United
States health services system is to find better ways for
primary-care and specialist physicians to work together so
that health services are more effective, efficient and
equitable," Starfield said.
The study, co-authored by Starfield, Lelyu Shi, Atul
Grover and James Macinko, was supported by a grant from the
Bureau of Primary Health Care, Health Resources and
Services Administration at the U.S. Department of Health
and Human Services.