Chapel Hill -- For the first time in four years, slightly fewer primary-care physicians are practicing in North Carolina, a new University of North Carolina at Chapel Hill report indicates. The total dropped by 16 doctors, from 6,380 in 1998 to 6,364 in 1999, a decline of 0.3 percent. The decrease follows an 8.4 percent jump in such physicians between 1997 and 1998 and a 4.8 percent increase from 1996 to 1997, according to the Cecil G. Sheps Center for Health Services Research's 1999 N.C. Health Professions Data Book. In 1999, 40 counties experienced a reduction in their number of primary-care physicians, while only 15 counties saw a drop in 1998.
For 22 years, Sheps center staffers have compiled the data book as an annual report on health-care practitioners in North Carolina. Primary-care specialties are considered to be family practice, general practice, internal medicine, obstetrics-gynecology and pediatrics. Of those, only family practice and pediatrics saw slight increases.
"Slowing of the growth of primary-care physicians in our state might just reflect a bump in the data given that the N.C. Medical Board has recently revised the way it issues licenses," said Dr. Thomas C. Ricketts, deputy director of the Sheps center and associate professor of health policy and administration at the UNC-CH School of Public Health. "However, if it is real and reflects an emerging trend, we should worry about whether the state's primary-care doctor supply is going to be able to keep up with its rapid population growth."
"These data should cause us to look carefully at year-to-year figures, but the long-range trend has been positive even with occasional jumps and dips."
In contrast to the primary-case physician supply, strong growth occurred in the state's nurse practitioner corps for the fifth year in a row, Ricketts said. Their numbers rose 77.5 percent between 1995 and 1999 and about 8 percent between 1998 and 1999 for a total of 1,425.
The number of physician assistants increased to 1,654, reflecting a growth rate of 15 percent, from 1998 to 1999 and 46 percent since 1994. Additionally, the state's certified nurse midwife supply increased by more than 10 percent annually for the past four years, now standing at 153.
Since nurse practitioners, physician assistants and certified nurse midwives offer primary care, a relationship might exist between their rise and the small decline in primary-care doctors, the researcher said.
"We're sensing that access to primary-care physicians is tight in some cities that are growing rapidly," Ricketts said. "I've been told that it's hard to get an appointment with a primary-care doctor in Raleigh. Our statistics indicate that adequate numbers of doctors work in the region, but there have been a lot of organizational changes among doctors' groups and many new people in the area who may not know how to negotiate the system or have not settled in with a regular physician." The new report describes in detail the supply and distribution of 16 groups of licensed health professions by county and region, including dentists, dental hygienists, registered nurses, licensed practical nurses and physical therapists.
The way medical practice is organized has been changing rapidly, and it will take time for the organizational changes to stabilize, Ricketts said.
"Doctors are able to do more in less time because of new technology and overall improvements in efficiency in the organization of medical care," Ricketts said. "However, we have learned that, overall, they're seeing fewer patients because they're working slightly shorter weeks and fewer weeks a year."
Fewer working hours for physicians appears tied to the trend that younger practitioners now work in large health provider organizations rather than in small offices and partnerships, he said. "In solo doctors' offices and small groups or partnerships, physicians were in effect on call most of the time, and they tended to work long hours and take relatively little time away from the practice," Ricketts said. "That is not the norm anymore. There may also be a rise in time needed for administrative work and other duties that take them away from direct patient care."
The data system is funded by the North Carolina Area Health Education Centers and UNC-CH's Office of the Provost. To order the 1999 edition of the data book, send an e-mail request to hp_data_coord@mail.schsr.unc.edu. A free pocket guide, "1999 Health Professions Supply by County," also is available.
Note: Ricketts can be reached at 919-966-5541. Data coordinator Laura Smith can supply information for individual counties, 966-7112.