In the shadow of the COVID-19 pandemic, family physicians are concerned about their ability to keep practices open despite stay-at-home orders issued by governors, patient concerns about visiting doctors’ offices, limited access to personal protective equipment, and potentially being reassigned to hospital-based care. These and other factors may lead to drastic reductions in practice hours and staff.
The “Coronavirus Pandemic-Related Potential Family Medicine Office Closures and Economic Impact, April through June 2020” visualization (https://healthlandscape.org/covid19/) presents a “what-if” family physician attrition scenario. Data sources include the National Plan and Provider Enumeration System (NPPES), the American Medical Association (AMA) Physician Economic Impact Studyand the Robert Graham Center Social Deprivation Index (SDI). Initial family physician counts by U.S. county were derived from the February 2020 NPPES including all Family Medicine typologies. Initial total number of jobs supported by the physicians and the amount of wages and salaries were derived from the AMA Physician Economic Impact Study. We used estimates shown in Table 3 in each of the state reports to calculate the number of jobs per family physician and the wages and salaries attributable to family physicians. State-by-state reports are available online. These multipliers were then applied to counts of family physicians from the NPPES and summed to get estimated Jobs and Wages & Salaries numbers.
The model assumes 3-4% attrition (loss) of individual family physicians each week. In the model, each county loses a minimum of three percent of its family physicians per week. An additional amount of attrition is factored in based on SDI scores which range from 0 to 100, with larger scores indicating more deprivation. SDI is included because populations with higher SDI scores may have higher community risk. No additional attrition above the 3% is included for counties that have an SDI score of 0, while a county with an SDI score of 100 will have the maximum level of 4% attrition. For example, attrition rates for counties with an SDI score of 43 were adjusted to 3.43%.
On March 31, 2020, there were 138,707 family physicians, whose practices supported 1,872,907 jobs, including those of the physicians, for a total of $154,283,373,121 in wage and salaries. At that time, 750 counties had population to family physician ratios greater than 3,500:1. Using constant losses across the time period, there will be 58,025 fewer family physicians working in their practices, resulting in a total job loss of 784,133 and lost wages and salaries of $64,645,325,573. Furthermore 1,841 counties would have population to family physician ratios greater than 3500:1.
HealthLandscape develops, administers, and markets geospatial analysis software tools and professional services. HealthLandscape has extensive experience in GIS applications relating to health centers and primary care and works closely on all projects as a team. Mark Carrozza, MA; Jene Grandmont, MA; Dave Grolling, MS; Jessica McCann, MS; Jennifer Rankin, PhD; Michael Topmiller, PhD.
About the Robert Graham Center
The Robert Graham Center aims to improve individual and population healthcare delivery through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy deliberations from the local to international levels. Jack Westfall, MD.
 https://download.cms.gov/nppes/NPI_Files.html. Data accessed February 17, 2020.
 https://www.physicianseconomicimpact.org/. Accessed March 16, 2020.
 https://www.graham-center.org/rgc/maps-data-tools/sdi/social-deprivation-index.html. 2017 SDI uses data from 2013-2017 American Community Survey.
For an example, see the Ohio report: https://www.physicianseconomicimpact.org/pdf/FullStateReports/OH-Study.pdf.