The news: 29% of patients who received medical services between 2016 and 2022 didn’t see a primary care physician (PCP), per a recent study from FAIR Health. And 44% of providers who performed those services weren’t physicians.

Nonprofit FAIR Health searched its extensive database of private healthcare claims (which includes Medicare Advantage but excludes traditional Medicare, Medicaid, CHIP, and state and local claims) to find where PCPs and nonphysicians were dispensing primary care.

Digging into the data: Several states and US territories allow nurse practitioners (NPs) to perform primary care services to varying degrees, per the American Association of Nurse Practitioners.

FAIR Health reported that:

• At 26.4%, Mississippi had the highest rate of patients seeking primary care from NPs, followed by Maryland (17.9%), Arizona (17.2%), Kansas (16.9%), and Indiana (16.2%).
• Just 1.7% of primary care patients in Hawaii and California saw an NP—the lowest level—followed by Michigan (3.0%), Virginia (3.6%), and Pennsylvania (3.9%).

Arizona, Kansas, and Maryland are among the 29 states and US territories that let NPs evaluate patients, order and interpret diagnostic tests, and initiate and manage treatments like prescribing medications.

Why it matters: Primary care is the gateway to healthcare—it’s typically the first point of contact for patients seeking care.

But the pandemic exacerbated physician burnout to the highest levels across all specialties, including among PCPs, per the Medscape Physician Burnout and Depression Report 2023:

• 60% of internal medicine doctors, 59% of pediatricians, 58% of OB/GYNs, and 57% of family medicine physicians reported feeling burned out.

Our take: Patients are voting with their feet when it comes to getting the healthcare services they need—when they need them. Our “Healthcare Patients by Walk-in Facility”  forecast shows that an increasing number of patients are choosing retail health clinics and urgent care centers over traditional primary care practices.

• 154.8 million US adults—59.3% of the population—got in-person care at a primary care practice at least once in 2021. But that number decreased slightly in 2022 and is projected to continue dropping, per our estimates.
• Conversely, while just 23.8% of US adults received in-person care at a retail health clinic in 2020, that number spiked to 30.3% this year. We project it will rise to 32.8% in 2024.
• More adult patients also turned to urgent care clinics in 2022 (95.9 million people) than in 2020 (89.3 million). We project that to increase to 98.2 million adult patients, or 36.7% of the population, in 2024.

This article originally appeared in Insider Intelligence's Digital Health Briefing—a daily recap of top stories reshaping the healthcare industry. Subscribe to have more hard-hitting takeaways delivered to your inbox daily.

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