America’s shortage of primary care doctors and nurse practitioners has a downstream effect in the nation’s operating rooms, a new study finds.

And patients suffer as a result.

In all, people living in areas with the most severe shortages of primary care providers have a much higher risk of having emergency surgery, rather than a scheduled operation, compared with people with the same condition who live in areas with less dire primary care shortages.

Those living in the areas with the lowest availability of primary care providers also have a higher chance of suffering complications after surgery, and needing to go back to the hospital after they’ve left it, according to the findings in the March issue of the journal Health Affairs from a team at Michigan Medicine, the University of Michigan’s academic medical center.

When timing matters
The team looked at data for people with traditional Medicare coverage who had operations for conditions where timing can really matter: colectomy to remove a cancerous area of the colon, repair of a hernia, and repair of aneurysms in wall of the aorta, the body’s largest blood vessel.

They focused only on people living in areas classified by the federal government as having a shortage of primary care providers. They then divided these areas into five levels of shortage.

In all, nearly 38% of the patients living in the more severe shortage areas had their operations on an emergency basis, compared with 30% of those living in the areas with the least severe shortages.

Those living in areas with more severe shortages also had a higher risk of serious complications from surgery (15% vs. nearly 12%), and those living in the most severe shortage areas also had a higher risk of readmission to the hospital (nearly 16% vs. 13.5%).

Rural area care
Lead author Sara Schaefer, M.D., said her experience growing up in Idaho and going to medical school at the University of Washington -- where she learned alongside primary care providers serving huge rural areas -- informed her interest in the topic. She is now a resident in the U-M Department of Surgery and a healthcare administration fellow at the Center for Healthcare Outcomes and Policy, and notes that she and her colleagues operate on many patients who travel from rural areas of Michigan, especially for emergency operations.

“The primary care provider shortage is a key piece in accessing care, because if you have no access to primary care, that impacts your access to specialists,” she said.

“A scheduled surgical case is always better than an emergency case in outcomes, costs and impact on the patient’s life, so the role of the primary care provider in identifying a potential issue, and referring a patient for diagnostic imaging and surgery, can make a major difference in addressing an urgent problem before it becomes an emergency.”

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