Colorado’s Primary Care Workforce: Regional Disparities

What good is an insurance card if there aren’t enough health care providers? 

Policy makers, patient advocates and other experts have been asking this question since passage of the Affordable Care Act and related policy changes set the stage for an influx of newly insured people.

A new study released today by the Colorado Health Institute, Colorado’s Primary Care Workforce: A Study of Regional Disparities, provides an in-depth picture of the state’s primary care workforce, both statewide and across 21 regions.

The analysis provides, for the first time, the ability to compare the primary care workforce by region. And it creates a baseline to measure it over time. It also looks specifically at Colorado’s capacity to care for Medicaid enrollees. This is information that a range of Colorado stakeholders have asked the Colorado Health Institute to provide.

Findings from the study show that, statewide, Colorado has strong primary capacity when compared to a standard panel size ratio of 1,900 patients for each full-time practicing primary care physician. Colorado’s overall population-to-physician ratio is 1,873:1.

But the study clearly shows that Colorado must think about its health care workforce on a regional and community level. There are disparities across the state.

Denver County has 1,348 residents for each full-time practicing primary care physician. Less than an hour’s drive to the east, in a rural region consisting of Cheyenne, Elbert, Kit Carson and Lincoln counties, there are 5,635 residents for each full-time primary care physician – or more than four times as many.

The nine regions in the state with the lowest capacity of primary care need a total of 258 additional full-time primary care physicians to reach the benchmark level.

To put that in context, over the past five years, Colorado has seen a net increase of just 100 primary care physicians. So training 258 physicians – and having them locate in the regions where they are most needed – will be a tall order. 

There are regional disparities in Medicaid primary care capacity as well, disparities that will only become more pronounced as the expansion of Medicaid eligibility is fully realized.

Five regions stand out as both relatively low in primary care capacity for the general population as well as primary care available to Medicaid enrollees. These “hot spots” are:

• El Paso (Region 4),
• Cheyenne, Elbert, Kit Carson and Lincoln (Region 5),
• Eagle, Garfield, Grand, Pitkin and Summit (Region 12),
• Chafee, Custer, Fremont, and Lake (Region 13)
• Clear Creek, Gilpin, Park and Teller (Region 17)

There are no silver bullets for ensuring more equitable statewide primary care capacity. But there are research-based options for improving the distribution of providers and enhancing the capacity already in the system.

The study points to the need to focus education, recruitment and retention on providers likely to serve in rural and underserved areas. It also reviews findings that enhanced use of technology and the delegation of care among a primary care team can help address the issue.