Primary care really does make you live longer: Study

The latest research, a 2019 JAMA Internal Medicine study found that every extra 10 primary care physicians – the US equivalent of GPs – per 100,000 population is associated with a 51.5 day increase in life expectancy, and an up to 1.4% decline in deaths from common causes like cancer and heart disease.
 
The epidemiological study also found that the same increase in specialist doctors led to only a 19.2 day increase in life expectancy.
 
It follows the much-cited 2007 Macinko, Starfield and Shi meta-analysis of 17 studies that examined links between primary care physician numbers and health outcomes, which found that each additional primary care doctor per 10,000 population was associated with an average mortality decline of 5.3%.
 
RACGP Victoria Deputy Chair Dr Karen Price recently seized on the findings to point out ‘primary care saves more lives than specialty care, with the biggest impact in cardiovascular disease, cancer and respiratory tract disease’ in a Croakey article.
 
‘Notably, these are disease-specific cases where prevention, screening and early detection – which all occur in primary care – play a significant role in reducing deaths. So ‘health’ is not about the MRI scan or the ‘heart health’ check-up,’ she wrote.
 
JAMA study lead author Dr Sanjay Basu told Reuters that a greater supply of primary care doctors appears to increase the chance a patient will be treated for cardiovascular risk factors or have a major cancer caught early.
 
The study also found that people who move to areas with more primary care physicians have substantially higher survival rates – up to 114.2 days per decade for every 10 additional primary care physicians per 100,000 people.
 
The US is currently grappling with a growing shortage of primary care doctors, with estimates by the Association of American Medical Colleges of a major shortfall of up to 120,000 doctors within 11 years. American medical graduates are increasingly moving into higher-income specialties like cardiology or orthopaedic surgery.
 
The study found that the average number of primary care doctors in the US declined from 46.6 per 100,000 to 41.1 between 2005 and 2015, due particularly to drops in rural areas.
 
US life expectancy is also declining for the first time in more than 20 years amid rising death rates from chronic diseases, suicide and heart disease, which some have linked to the drop in primary care physicians.
 
The UK is also struggling, with the first sustained drop in GP numbers for half a century registered this year. GP numbers have fallen to 60 per 100,000 population, down from almost 65 in 2014.
 
In Australia, by contrast, there is a mixed picture. GP numbers are rising, but there is a perennial deficit in rural, regional and remote areas.
 
‘There are few incentives to go into primary care among US medical school graduates,’ Dr Basu said.
 
‘Pay tends to be lower, burnout rates higher and prestige lower.’
 
The association of primary care doctor numbers with life expectancy was around one-fifth the size of the association of poverty with life expectancy, and approximately two-thirds the magnitude of the association of tobacco with life expectancy, the JAMA study found.
 
The study analysed data from more than 3000 US counties and more than 7000 primary care service areas, and controlled for covariates such as poverty levels, educational background, numbers of people without health insurance, and regular use of tobacco.

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