The Impact of Changes in Primary Care Clinicians' Work Effort on the Health of Older Adults

There are demonstrated benefits of comprehensive, continuous, and coordinated primary care for older adults, ranging from higher rates of appropriate preventive care receipt to lower rates of hospitalization and mortality. However, the benefits of strong primary care are threatened by an impending primary care workforce crisis, exacerbated by prevalent trends of primary care physician (PCP) workforce attrition and clinical effort reduction. Partly in response to these trends, there is increasing representation of NPs and PAs, collectively referred to as advanced practice clinicians (APCs), in the primary care workforce. However, burnout, intent to leave, and intent to reduce clinical effort are also prevalent among primary care APCs. These trends across primary care clinicians (PCCs; comprising physicians, NPs, and PAs) may significantly threaten quality of and access to care for older adults. At present, there is limited evidence to inform healthcare leaders and policy makers about how primary care workforce disruptions impact access to and quality of primary care received by older adults. There is additionally insufficient information on the actionable factors associated with PCC turnover and PCC reductions in clinical effort. In this grant, we will leverage data from Medicare fee-for-service and Medicare Advantage, which together provide coverage for 93% of older adults, in order to: 1) quantify the number of Medicare patients impacted by PCC turnover and sustained reductions in billed clinical effort and identify factors associated with these work effort changes; 2) assess the impact of PCC turnover and PCCs’ sustained reductions in billed clinical effort on patterns of primary care receipt and non-primary care utilization, including emergency department visits and hospitalizations; and 3) assess the impact of PCC turnover and sustained reductions in billed clinical effort on quality of care for older adults. All analyses will be conducted for the overall population of older adults as well as for subgroups of more vulnerable older adults, including those with dementia, multiple chronic conditions, and from underserved groups (e.g., dually eligible for Medicaid). Additionally, analyses will be conducted for physicians and APCs separately, and for the overall study period and comparing the pre- and post-COVID periods. The results from this study will elucidate how changes in PCCs’ work patterns influence the care of the growing US population of older adults. They will provide actionable insights for leaders seeking to design clinical systems and policies that enhance primary care for older adults. Overall, this proposal will enhance the ability of clinical, operational, and policy leaders to maintain the effort of the primary care workforce and optimize care for older adults. Project Number: 1R01AG092810-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Lisa Rotenstein (+1 co-PI) | Institution: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, SAN FRANCISCO, CA | Award Amount: $680,086 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-P (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11297315